Clinical Decision Rule for C-Spine Clearance in the Netherlands, a National Survey

Introduction: Although validated clinical decision rules exist to clear the cervical spine (C-spine) after blunt trauma it seems that no uniform policy is used in Dutch Emergency Departments. In this national problem-analysis we assessed factors that could hinder implementation of these decision rules and whether there was interest in developing a national guideline to clear the C-spine. Methods: During an expert-meeting a questionnaire was developed. This questionnaire was send to all members of the Dutch societies of Radiology, Traumatology and Emergency Physicians. Completion of the questionnaire occurred anonymous and was based on goodwill. Results: From the 222 respondents 55% used the ATLS guidelines for clearing the C-spine. In total, 7% used a combination of clinical decision rules5 and 5% did not use any criteria.98% was willing to accept a national guideline. Main demands were that the future clinical decision rule had to be evidence-based and practical for daily use. In 33% the NEXUS criteria were suggested for implementation and in 31% the criteria within the ATLS guidelines. Factors suggested to hinder implementation of clinical decision rules were mostly related to the complexity of the decision rules, the trauma team leader’s experience and the level of cooperation within the trauma team. Conclusion: There is no uniform policy on how to clear the C-spine after blunt trauma in Dutch Emergency Departments. This problem analysis showed that there is general interest in a national guideline dictating one simple and validated clinical decision rule. A strategy will be developed to implement such a clinical decision rule with specific attention to overcome the aforementioned potentially hindering factors.