Computed Tomography for Early and Safe Discontinuation of Cervical Spine Immobilization in Obtunded Multiply Injured Patients
Why this work is in the frame
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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.
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Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 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 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 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 it