Degree Name

Master of Science in Nursing (MSN)

Document Type

Major Paper

School

School of Nursing

Department

Nursing

Date of Original Version

5-13-2017

Abstract

In the United States and Canada, more than 13 million trauma patients are at risk for cervical spine injury (CSI). To date, providers use computerized tomography (CT) to rule out CSI in these patients. Cervical spine immobilization with the use of rigid cervical collars can be uncomfortable, delays hospital transport, and has a modest morbidity. The Canadian Cervical Spine Rule (CCR) is a screening tool used in emergency departments (ED) as a screening tool to rule out CSI to avoid unnecessary CTs. The purpose of this project is to complete a retrospective chart review to evaluate if emergency departments can apply the CCR to reduce cervical spine radiographs in the adult patient with suspected CSI. The study was a retrospective chart review, which took place at a level 2 trauma center emergency department in a community teaching hospital reviewing patient records and radiological findings in relation to the potential benefit of using the CCR in CSI assessment. The sample was a non-probability convenience sample of patients who have had a cervical spine radiograph in the ED. One hundred charts were reviewed and 60 patient records were included in the study. Of the 60 records included in the study, half met high risk criteria requiring cervical spine radiography. Of the 30 records meeting low risk criteria, only 2 charts had complete documentation including neck range of motion (ROM). One had normal ROM and one was unable to actively rotate neck. There were 8 records that documented “normal range of motion” but did not specifically note normal neck ROM. It is difficult to definitively state that 28 CTs could have been prevented, as there was inadequate neck range of motion documentation. There were no cervical spine injuries detected by CT in this study. As with previous studies, the data shows that the CCR maintains its sensitivity but has low specificity. It remains that clinicians still rely on radiology evidence to rule out CSI rather than assessment tools.

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