Computed Tomography for Early and Safe Discontinuation of Cervical Spine Immobilization in Obtunded Multiply Injured Patients
Bibliographic record
Abstract
BACKGROUND: Evaluation of the cervical spine (c-spine) in obtunded severely injured trauma patients is controversial, and spine immobilization is frequently prolonged. We examined the effect of two different c-spine evaluation protocols on c-spine immobilization and clinical outcomes. METHODS: We prospectively evaluated consecutive intubated and mechanically ventilated patients admitted to the surgical intensive care unit (ICU) of a Level I academic trauma center with a diagnosis of multiple blunt injuries who had normal findings on high-resolution helical computed tomogram of C1 to T1 with reconstructions (HCTrecon). From July 1, 2003 to June 30, 2005 (n = 140), the findings of HCTrecon and either clinical examination or magnetic resonance imaging (MRI) were required to be normal to discontinue c-spine immobilization (clinical/MRI protocol). From July 1, 2005 to June 30, 2006 (n = 75), the policy was changed to require normal finding only on HCTrecon to discontinue c-spine immobilization (HCTrecon protocol). RESULTS: Patients evaluated by the clinical/MRI and HCTrecon protocols had similar baseline characteristics. Compared with clinical/MRI patients, HCTrecon patients had their c-spines immobilized for fewer days (median, 6 days vs. 2 days; p < 0.001), were less likely to experience a complication of c-spine immobilization (64% vs. 37%, p = 0.010), required shorter periods of mechanical ventilation (median, 4 days vs. 3 days; p = 0.011), and had shorter stays in the ICU (median, 6 days vs. 4 days; p = 0.028) and hospital (median, 16 days vs. 14 days; p = 0.043). There was no difference in hospital mortality (13% vs. 16%, p = 0.920) and no missed c-spine injuries in either group. CONCLUSION: Discontinuation of c-spine precautions based on the normal findings of HCTrecon decreases the duration of c-spine immobilization in obtunded severely injured patients and is associated with fewer complications, fewer days of mechanical ventilation, and shorter stays in the ICU and hospital.
Fetched live from OpenAlex and de-inverted. Abstracts are not stored in this database: the inverted indexes are 8.6 GB of the frame’s 9.3 GB of text, and the host has 13 GB free.
How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.004 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".