Patient management guidelines for blunt cervical spine injuries. Development of an algorithm

Background. The aim of this study was to present existing publications, describing various diagnostic procedures as well as considering the evidence supporting them, to develop a recommendation for diagnosis. Material and methods., We reviewed relevant publications between 1966 and 2004 by a systemic literature search in MEDLINE, EMBASE, National Guideline Clearinghouse, Cochrane Library as well as a manual reference search. Keywords were cervical spine, cervical vertebrae, spinal, spinal cord, injury, trauma, fracture, dislocation, imaging, radiography, flexion, extension, fluoroscopy, computed tomography, computed scanning, and magnetic resonance imaging. The selected search results were then classified into levels of evidence. Results. From among a total of 10,000 publications, 137 relevant publications were stringently reviewed. The level of evidence is on the whole limited due to deficit data; therefore, only class II-III recommendations are possible. We developed an algorithm for the diagnostic approach to suspected trauma of the cervical spine. This clinical algorithm displays the complex diagnosis of cervical spine injury in a clear and logically structured process. Conclusions. The diagnostic algorithm for cervical spine injury meets the presently required standards and maximizes care for the newly injured. The development, which can be followed using evidence-based medicine, is transparent and therefore aids the decision process when choosing an adequate diagnostic procedure.