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Removal of C-spine protection by A&E triage nurses: a prospective trial of a clinical decision making instrument
  1. E Pitt,
  2. D K Pedley,
  3. A Nelson,
  4. M Cumming,
  5. M Johnston
  1. Accident and Emergency Department, Ninewells Hospital and Medical School, Dundee, UK
  1. Correspondence to:
 Dr D Pedley
 Accident and Emergency Department, Ninewells Hospital and Medical School, Dundee DD1 9SY, UK; dpedley{at}


Objective: To investigate if triage nurses could safely apply a set of clinical criteria, removing hard collars and spinal boards at initial triage assessment.

Methods: The Nexus clinical decision rules were applied by trained triage nurses to patients who attended the department with cervical collars and /or on spinal boards. Patients were excluded if they were felt to be in need of immediate medical assessment. Data were collected on the time to nursing assessment, time to medical assessment and time spent restrained. Patients were followed up until discharge and their radiological diagnosis confirmed. Hospital records were checked to ensure that no patients re-presented with injuries that had been missed at initial assessment.

Results: In total, 112 patients were included in the study. Clinical criteria were met in 59 patients and their collar removed at triage assessment. For low risk patients, this reflects a mean reduction in time spent restrained of 23.3 minutes (p<0.005; 95% confidence interval 20.18 to 26.54). No patient who had a collar removed was found to have a significant injury.

Conclusions: Simple criteria can be applied by accident and emergency triage nurses to allow safe removal of cervical collars and spinal boards. The reduced time patients spent immobilised represents an important improvement in patient care.

  • A&E, accident and emergency
  • NEXUS, National Emergency X Radiography Utilization Study
  • Cervical spine
  • collars
  • spinal boards

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  • Competing interests: none declared

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