Cervical Collar Removal Times at a Level 1 Trauma Center: A Needs Assessment

Trauma patients remain in cervical collar neck braces for up to 12 hours awaiting final radiology readings. These final readings are necessary before the collar can be removed. The extended wearing of cervical collars potentially leads to worsening fractures, ligamentous injury, increased spinal movement, decreased ventilation, and worsened neurologic outcomes. We conducted a retrospective chart review of 1106 adult trauma patients from an Electronic Health Record database from 11/2015-9/2017. Data abstracted includes time of cervical spine CT scan, time of preliminary resident radiologist reading, and time of final attending radiologist reading. We had a total of 1,095 patients who underwent computerized tomography (CT) of the cervical spine during their trauma evaluation. Preliminary readings were provided by resident-level radiologists within 3 hours of the scan, despite the time of day (p <0.01). Final readings by attending radiologists were provided within 2.5 hours if the scan was completed from 7am-5pm. The final readings took up to 6 hours to complete on average during the hours of 5pm-7am (p <0.01), with some patients waiting up to 14 hours for their final scan results. A significant delay in cervical spine reading times was identified from the resident preliminary reading to the attending radiologist final reading. An executive summary of these findings was presented to trauma and radiology stakeholders. Stakeholders made three key decisions for their next steps in addressing prolonged evening radiology reading times. These steps included: conducting a study to determine if trauma patients who were otherwise uninjured were waiting only for cervical spine film readings in order to be discharged, determine if the volume of ordered scans was medically necessary for these patients, and implement a process to record when collars are actually placed and removed to identify areas for improvement in the overall length of time patients remain in cervical collars.