Safe cervical spine clearance in adult obtunded blunt trauma patients on the basis of a normal multidetector CT scan—A meta-analysis and cohort study

Injury ◽  
2013 ◽  
Vol 44 (11) ◽  
pp. 1589-1595 ◽  
Author(s):  
Mushahid Raza ◽  
Samer Elkhodair ◽  
Asif Zaheer ◽  
Sohail Yousaf
Keyword(s):  
Cohort Study ◽  
Cervical Spine ◽  
Ct Scan ◽  
Blunt Trauma ◽  
Multidetector Ct ◽  
Meta Analysis ◽  
Trauma Patients

Comparative effectiveness of using computed tomography alone to exclude cervical spine injuries in obtunded or intubated patients: meta-analysis of 14,327 patients with blunt trauma

2011 ◽  
Vol 115 (3) ◽  
pp. 541-549 ◽  
Author(s):  
David M. Panczykowski ◽  
Nestor D. Tomycz ◽  
David O. Okonkwo
Keyword(s):  
Cervical Spine ◽  
Ct Scan ◽  
Blunt Trauma ◽  
Meta Analysis ◽  
Acute Injury ◽  
Trauma Patients ◽  
Study Quality ◽  
Cervical Spine Injuries ◽  
Spine Injuries ◽  
Unstable Cervical Spine

Object The current standard of practice for clearance of the cervical spine in obtunded patients suffering blunt trauma is to use CT and an adjuvant imaging modality (such as MR imaging). The objective of this study was to determine the comparative effectiveness of multislice helical CT alone to diagnose acute unstable cervical spine injury following blunt trauma. Methods The authors performed a meta-analysis of studies comparing modern CT with adjunctive imaging modalities and required that studies present acute traumatic findings as well as treatment for unstable injuries. Study quality, population characteristics, diagnostic protocols, and outcome data were extracted. Positive disease status included all injuries necessitating surgical or orthotic stabilization identified on imaging and/or clinical follow-up. Results Seventeen studies encompassing 14,327 patients met the inclusion criteria. Overall, the sensitivity and specificity for modern CT were both > 99.9% (95% CI 0.99–1.00 and 0.99–1.00, respectively). The negative likelihood ratio of an unstable cervical injury after a CT scan negative for acute injury was < 0.001 (95% CI 0.00–0.01), while the negative predictive value of a normal CT scan was 100% (95% CI 0.96–1.00). Global severity of injury, CT slice thickness, and study quality did not significantly affect accuracy estimates. Conclusions Modern CT alone is sufficient to detect unstable cervical spine injuries in trauma patients. Adjuvant imaging is unnecessary when the CT scan is negative for acute injury. Results of this meta-analysis strongly show that the cervical collar may be removed from obtunded or intubated trauma patients if a modern CT scan is negative for acute injury.

40-Slice Multidetector CT: Is MRI Still Necessary for Cervical Spine Clearance after Blunt Trauma?

2010 ◽  
Vol 76 (2) ◽  
pp. 157-163 ◽  
Author(s):  
Jay Menaker ◽  
Deborah M. Stein ◽  
Allan S. Philp ◽  
Thomas M. Scalea
Keyword(s):  
Cervical Spine ◽  
Blunt Trauma ◽  
Trauma Registry ◽  
Clinical Symptoms ◽  
Multidetector Ct ◽  
Trauma Patients ◽  
Mri Findings ◽  
Persistent Symptoms ◽  
Operative Repair ◽  
Ct Technology

We have recently demonstrated that 16-slice multidetector CT (MDCT) is insufficient for cervical spine (CS) clearance in patients with unreliable examinations after blunt trauma. The purpose of this study was to determine if a negative CS CT using 40-slice MDCT is sufficient for ruling out CS injury in unreliable blunt trauma patients or if MRI remains necessary for definitive clearance. In addition, we sought to elucidate the frequency by which MRI alters treatment in patients with a negative CS CT who have a reliable examination with persistent clinical symptoms. The trauma registry was used to identify all patients with blunt trauma who had a negative CS CT on admission using 40-slice MDCT and a subsequent CS MRI during their hospitalization from July 2006 to July 2007. Two hundred thirteen patients were identified. Overall, 24.4 per cent patients had abnormal MRIs. Fifteen required operative repair; 23 required extended cervical collar; and 14 had collars removed. A total of 8.3 per cent of patients with an unreliable examination and 25.6 per cent of reliable patients had management changed based on MRI findings. Overall, MRI changed clinical practice in 17.8 per cent of all patients. Despite newer 40-slice CT technology, MRI continues to be necessary for CS clearance in patients with unreliable examinations or persistent symptoms.

scholarly journals Impact of MRI on changing management of the cervical spine in blunt trauma patients with a ‘negative’ CT scan

2016 ◽  
Vol 1 (1) ◽  
pp. e000016 ◽  
Author(s):  
Mohamed A Mohamed ◽  
Karl D Majeske ◽  
Gul Sachwani-Daswani ◽  
Daniel Coffey ◽  
Karim M Elghawy ◽  
...  
Keyword(s):  
Cervical Spine ◽  
Ct Scan ◽  
Blunt Trauma ◽  
Trauma Patients

The Current Role of Magnetic Resonance Imaging for Diagnosing Cervical Spine Injury in Blunt Trauma Patients with Negative Computed Tomography Scan

2012 ◽  
Vol 78 (10) ◽  
pp. 1156-1160 ◽  
Author(s):  
Meghann L. Kaiser ◽  
Matthew D. Whealon ◽  
Cristobal Barrios ◽  
Allen P. Kong ◽  
Michael E. Lekawa ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Computed Tomography ◽  
Cervical Spine ◽  
Magnetic Resonance ◽  
Blunt Trauma ◽  
Multidetector Ct ◽  
Spine Injury ◽  
Trauma Patients ◽  
Resonance Imaging ◽  
Mri Findings

Clearance of cervical spine (CS) precautions in the neurologically altered blunt trauma patient can be difficult. Physical examination is not reliable, and although computed tomography (CT) may reveal no evidence of fracture, it is generally believed to be an inferior modality for assessing ligamentous and cord injuries. However, magnetic resonance imaging (MRI) is expensive and may be risky in critically ill patients. Conversely, prolonged rigid collar use is associated with pressure ulceration and other complications. Multidetector CT raises the possibility of clearing CS on the basis of CT alone. We performed a retrospective review at our Level I trauma center of all blunt trauma patients with Glasgow Coma Scale Score 14 or less who underwent both CT and MRI CS with negative CT. One hundred fourteen patients met inclusion criteria, of which 23 had MRI findings. Seven (6%) of these had neurologic deficits and/or a change in management on the basis of MRI findings. Although use of the single-slice scanner was significantly associated with MRI findings (odds ratio, 2.62; P = 0.023), no significant clinical risk factors were identified. Patients with MRI findings were heterogeneous in terms of age, mechanism, and Injury Severity Score. We conclude that CS MRI continues play a vital role in the workup of neurologically altered patients.

64-Slice CT compared to MRI to clear cervical spine injury in high-risk GCS < 14 blunt trauma patients admitted to the ICU

Trauma ◽  
2017 ◽  
Vol 20 (1) ◽  
pp. 38-45
Author(s):  
Jessica McCallum ◽  
Patrick McLaughlin ◽  
Morad Hameed ◽  
Hussein D Kanji
Keyword(s):  
Cervical Spine ◽  
High Risk ◽  
Ct Scan ◽  
Blunt Trauma ◽  
Cervical Spine Injury ◽  
Spine Injury ◽  
Trauma Patients ◽  
Positive Finding ◽  
Clinically Significant ◽  
Significant Injury

Objective Clearance of cervical spine injury including ligamentous injury is of paramount importance as results of missed injury may have serious consequences. In obtunded patients, cervical spine clearance is challenging. This study sought to determine whether a negative 64-slice CT scan alone is sufficient to clear cervical spine injury. Patients and methods All consecutive blunt trauma patients admitted to a regional (level 1) trauma center from 1 April 2008 to 31 March 2012 were screened for inclusion in this study. High-risk, GCS < 14, blunt trauma patients were included if they were admitted to the intensive care unit, had a negative 64-slice CT, and MRI of diagnostic quality. GCS was measured at the time of CT scan. Patients with a positive finding on CT scan were excluded. All images were re-interpreted by a trauma radiologist blinded to clinical outcome. Details of missed injuries and clinical impact were reported. The primary outcome was missed clinically significant injury, defined as any injury requiring an additional intervention including continued immobilization or surgery. Results There were 5891 blunt trauma patients admitted to the ICU, 44 of whom met inclusion criteria. Patients had a median injury severity score of 35 and MRI three (2–9) days after CT. Eight of 44 (18%) patients had a positive finding on MRI and five of the findings were clinically insignificant. Three patients (7%) with focal neurologic findings on clinical exam had missed injuries requiring immobilization with a collar. Two of these patients had spine disease, which may have increased their injury risk. Conclusions In high-risk obtunded blunt trauma patients admitted to the ICU, a negative 64-slice CT scan alone is insufficient to clear clinically significant cervical spine injury, with a missed clinically significant injury rate of 7%. When considered with symmetric motor function, a negative 64-slice CT scan may be sufficient. A prospective study is required to confirm these findings.

Association between Mode of Transportation and Survival in Adult Trauma Patients with Blunt Injuries: Matched Cohort Study between Police and Ground Ambulance Transport

2021 ◽  
pp. 1-9
Author(s):  
Fouad A. Sakr ◽  
Rana H. Bachir ◽  
Mazen J. El Sayed
Keyword(s):  
Cohort Study ◽  
Survival Rate ◽  
Blunt Trauma ◽  
Survival Rates ◽  
Trauma Patients ◽  
Matched Cohort ◽  
Matched Cohort Study ◽  
Blunt Injuries ◽  
Ground Ambulance ◽  
Mode Of Transportation

Abstract Introduction: Early police transport (PT) of penetrating trauma patients has the potential to improve survival rates for trauma patients. There are no well-established guidelines for the transport of blunt trauma patients by PT currently. Study Objective: This study examines the association between the survival rate of blunt trauma patients and the transport modality (police versus ground ambulance). Methods: A retrospective, matched cohort study was conducted using the National Trauma Data Bank (NTDB). All blunt trauma patients transported by police to trauma centers were identified and matched (one-to-four) to patients transported by ground Emergency Medical Services (EMS) for analysis. Descriptive analysis was carried out. This was followed by comparing all patients’ characteristics and their survival rates in terms of the mode of transportation. Results: Out of the 2,469 patients with blunt injuries, EMS transported 1,846 patients and police transported 623 patients. Most patients were 16-64 years of age (86.2%) with a male predominance (82.5%). Fall (38.4%) was the most common mechanism of injury with majority of injuries involving the head and neck body part (64.8%). Fractures were the most common nature of injury (62.1%). The overall survival rate of adult blunt trauma patients was similar for both methods of transportation (99.2%; P = 1.000). Conclusion: In this study, adult blunt trauma patients transported by police had similar outcomes to those transported by EMS. As such, PT in trauma should be encouraged and protocolized to improve resource utilization and outcomes further.

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