Whatsup yall. A rainy Wednesday POTD comin at ya, fast and quick. Who's excited? Everybody. But you know what everybody isn't stoked about? Drunk trauma peeps. They stink. They can't give a good history. They literally stink. "SCAN EVERYTHING!" you may say, and you will never go wrong. Zap em with some good old fashioned radiology. If everything is fine, then what????
Can you clear that spine with a drunk traumatic patient with a negative CT spine? Well they still fail NEXUS criteria. Canadian is more EH.........maybe????
Thank god someone studied this. https://www.ncbi.nlm.nih.gov/pubmed/28723840
Basically they had a 3 year, prospective, multicenter trial, with appx 3000 drunkypants patients. Sensitivity of CT for any Cspine injury was 94%, specificity 99.5%, and NEGATIVE PREDICTIVE VALUE of 99.5%. HOT DAMN DIGGITY DAWG THATS SPECTACULAR.
EVEN BETTER, for clinically significant injuries, the NPV was 99.9%, and NO UNSTABLE CSPINE injuries were missed on initial CT.
Why does this matter? The study also showed that drunks stayed in collars 4X as long as sober peeps. It sucks. Try wearing a collar, even after a few brewskies.
Will this change your practice? Maybe? Will anybody listen to you if you want to clear these collars? Probably Not, but go ahead and show them this data, and then still be told no. But still, as always, research pushes forward telling us to just chillax people. Don't stress.