BOAST - Spinal Clearance in the Trauma Patient
All patients involved in significant blunt trauma must be assumed to have an unstable injury to their spine; the incidence is approximately 2% and increases up to 34% in the unconscious patient. 50% of spinal injuries occur in the thoracic or lumbar spine; 20% at two levels. Immobilisation with full spinal precautions for prolonged periods creates difficulties in intensive care units. Spinal immobilisation is associated with pressure sores and pulmonary complications and is not recommended for more than 48 hours. Audits in the UK suggest poor implementation of spinal clearance policies. In the neck ligamentous disruption without a major bony injury may lead to instability. Recent comparative evaluations have shown that a modern helical CT scanning with reformatting can demonstrate the subtle abnormalities offering high sensitivity and specificity in detecting unstable injuries of the cervical spine. Plain radiographs are insensitive in the neck and the upper thoracic spine. MRI scanning has high sensitivity but only moderate specificity and is logistically difficult for ICU patients.