We just had the discussion again and finally found a good and solid answer to it:
A 19 year old male was transferred to our unit from casualty with a GCS of 10 (E2, V3, M5) secondary to a little bit of... to many drinks. As he was found lying on the ground with no company an unwitnessed fall was considered and a rigid collar applied by paramedics. A c-spine CT-scan in the hospital showed no abnormalities and the patient was transferred to ICU for further treatment... with the rigid collar still in place!
The question soon arose whether it is safe to remove a rigid collar in the intoxicated and dazed patient after a normal c-spine scan or not. Some argued that the patient should also be examined clinically once sober in order to safely evaluate and clear the spine. As always by the way: The rigid collar was removed in ICU and no further problems evolved.
At that time we just knew it is safe to do so but now we seem to get some excellent evidence supporting this procedure.
Martin et al. have just published a
prospective multicenter study at 17 centers
in which they analyzed
10191 trauma patients that underwent CT of the c-spine during their primary evaluation (67% male, 83% car accidents or falls, mean ISS 11)
They found that
the intoxicated cohort had a lower incidence of c-spine injuries
c-spine CT had a sensitivity of 94%, a specifity of 99.5% and a negative predicitve value of 99.9%!
In words this means that a negative CT-result for a patient gives us a very high confidence that this negative result is true!
The Bottom Line:
Clearing the c-spine by CT-scan in the intoxicated patient is definitely safe, especially when there are no other injuries or history of a high velocity trauma.
Martin MJ et al. J Trauma Acute Care Surg. 2017 Jul 19