A synthesis of research examining timely removal of cervical collars in the obtunded trauma patient with negative computed tomography: an evidence-based review.

OBJECTIVE: Currently, the standard to clear the cervical spine in obtunded blunt trauma patients is computed tomography in combination with plain films, dynamic fluoroscopy, or magnetic resonance imaging. The objective of this study was to answer the question "Can computed tomography alone provide adequate clinical information to clear the cervical spine in the obtunded patient?" METHODS: The author performed a search of the literature for studies that compared computed tomography (CT) with other radiologic modalities utilized to clear the cervical spine in obtunded patients. PubMed, TRIPdatabase, SUMsearch, Cochrane library, and Google Scholar were the databases applied. Additional sources included bibliographies of selected articles. Studies that integrated CT scan with at least 1 other diagnostic examination were included. RESULTS: A review of 11 studies and 1 meta-analysis encompassing 2458 and 14327 patients, respectively, met inclusion criteria. The meta-analysis generated a negative predictor value for CT scan of 100% without evidence of acute injury with an overall sensitivity and specificity of 99.9% each. CONCLUSION: The results suggest that CT alone is a reliable clinical indicator to clear the cervical spine in obtunded patients.