General Trauma

Cervical Spine Clearance in the Obtunded Adult Blunt Trauma Patient

Activity Details
  • Credit Type: CME
  • Credit Amount: 0.75
  • Cost: $70.00
  • Release: Jul 6, 2015
  • Expires: Jul 5, 2018
  • Estimated Time to Complete:
    45 Minutes
  • System Requirements:
  • Average User Rating:
    (1 Rating)


Mayur B.  Patel Mayur B. Patel, MD, MPH, FACS
Assistant Professor of Surgery and Neurosurgery
Surgery/Trauma and Surgical Critical Care
Vanderbilt University Medical Center
Nashville, Tennessee
Staff Surgeon and Surgical Intensivist
Nashville VA Medical Center
Nashville, Tennessee

Needs Statement

Cervical spine (C-spine) collar clearance or removal is well established for the alert patient with or without symptoms; however, for the obtunded adult blunt trauma patient, it is unclear whether primary screening with computed tomography (CT) is sufficient or whether a second diagnostic adjunct is required. The imprecise and possible overly broad interpretations of the word obtunded along with continual advances in imaging technology confound the decision to remove the cervical collar after blunt traumatic injury. Indiscriminate reliance on cervical immobilization, confirmatory tests, and/or interventions without justification will drive up direct and indirect costs without demonstrable improvement in patient outcomes. It is important to understand the literature behind recent evidence-based recommendations that might be used to direct decision-making in the removal of a cervical collar from the adult obtunded blunt trauma patient.

Target Audience

Any provider involved in the cervical spine collar clearance for the obtunded blunt trauma patient.


Upon completion of this activity, participants will be able to:

  1. Recognize the term "obtunded" is imprecise and broadly defined in the literature.
  2. Discuss the negative predictive value of high-quality CT imaging in excluding the unstable cervical spine injury.
  3. Describe their institutional cervical collar clearance protocols.


This activity has been planned and implemented in accordance with the accreditation requirements and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint providership of the University of Kentucky College of Medicine, and Eastern Association for the Surgery of Trauma. The University of Kentucky College of Medicine is accredited by the ACCME to provide continuing medical education for physicians.

The University of Kentucky College of Medicine designates this enduring material for a maximum of 0.75 AMA PRA Category 1 Credit(s)™. Physicians should only claim credit commensurate with the extent of their participation in the activity.

The University of Kentucky College of Medicine presents this activity for educational purposes only. Participants are expected to utilize their own expertise and judgment while engaged in the practice of medicine. The content of the presentations is provided solely by presenters who have been selected for presentations because of recognized expertise in their field.

ACGME Competencies

  • Patient care
  • Medical knowledge
  • Practice-based learning and improvement

Faculty Disclosure

No speakers, authors, planners or content reviewers have any relevant financial relationships to disclose.

The material presented in this course represents information obtained from the scientific literature as well as the clinical experiences of the speakers. In some cases, the presentations might include discussion of investigational agents and/or off-label indications for various agents used in clinical practice. Speakers will inform the audience when they are discussing investigational and/or off-label uses.

Content review confirmed that the content was developed in a fair, balanced manner free from commercial bias. Disclosure of a relationship is not intended to suggest or condone commercial bias in any presentation, but it is made to provide participants with information that might be of potential importance to their evaluation of a presentation. 


This activity is jointly provided by the University of Kentucky and Eastern Association for the Surgery of Trauma.

CE Content Concerns


Concerns or complaints related to ACPE or ACCME standards may be submitted in writing to the Director of UK HealthCare CECentral by fax to 859-323-2920, or by mail to 2365 Harrodsburg Road, Ste B475, Lexington, KY 40504


  • The Director or his/her designee will review, investigate, forward and/or respond to complaints and will put forth a best effort to adjudicate the issue(s), along with CECentral staff members, within two (2) weeks of receipt of the grievance or complaint.
  • If needed, concerns, complaints, or grievances will be brought before the UK HealthCare CECentral Advisory Board.
  • Issues regarding activity content also will be reviewed and addressed by the Activity Director.
  • A written decision will be issued in a timely manner by the Director of UK HealthCare CECentral or his/herdesignee.
  • Grievances will be considered when planning future activities.

Appeal Procedure

  • Persons who wish to appeal a decision should address the appeal by email, fax or in writing to the Director of UK HealthCare CECentral within two (2) weeks of receipt of the response.
  • The Director will bring the appeal to the UK HealthCare CECentral Advisory Board.
  • The results of the appeal will be sent to the participant no later than two (2) weeks following the meeting of the board.