Development of a Hybrid Cervical Spine Clearance Algorithm in Trauma: Tackling the Challenges of the NEXUS Criteria and Canadian Cervical Spine Rule Utilization in a Low-Volume Tertiary Neuroscience Unit

Missed cervical spine injuries can have a devastating impact on the outcome of the trauma patient. Prolonged and unwarranted immobilization should also be avoided to reduce the risk of any potential complications. A systematic method to decide on the possibility of cervical spine injury early is therefore paramount. The Canadian C-spine (cervical spine) rule and the NEXUS (National Emergency X-Radiography Utilization Study) criteria are internationally validated methods of resolving the cervical spine in trauma patients. Peculiarities of patient populations can limit the utility of these tools, and local trauma units often need to adapt guidelines to suit their circumstances. This article describes the development of a local guideline, a hybrid protocol for the clearance of the cervical spine in adult trauma patients, applicable to a broader patient group, its advantages, preliminary impact, and the possibility of wider adoption.