Cervical Spine Imaging in Blunt Trauma Patients

2016 ◽  
Author(s):  
Christoph I. Lee
Keyword(s):  
Cervical Spine ◽  
Blunt Trauma ◽  
Trauma Patients ◽  
Clinical Context ◽  
Cervical Spine Injuries ◽  
Additional Information ◽  
Spine Imaging ◽  
Spine Injuries ◽  
Study Methodology ◽  
Spine Radiographs

This chapter, found in the back pain section of the book, provides a succinct synopsis of a key study examining the use of cervical spine imaging in blunt trauma patients. This summary outlines the study methodology and design, major results, limitations and criticisms, related studies and additional information, and clinical implications. The study presents a set of five diagnostic criteria that approach 100% sensitivity for identifying clinically important cervical spine injuries and could eliminate one-eighth of all cervical spine radiographs ordered for these patients. In addition to outlining the most salient features of the study, a clinical vignette and imaging example are included in order to provide relevant clinical context.

Cervical Spine Imaging in Alert and Stable Trauma Patients

2016 ◽  
Author(s):  
Christoph I. Lee
Keyword(s):  
Emergency Department ◽  
Back Pain ◽  
Cervical Spine ◽  
Clinical Implications ◽  
Trauma Patients ◽  
Clinical Context ◽  
Appropriate Use ◽  
Additional Information ◽  
Spine Imaging ◽  
Study Methodology

This chapter, found in the back pain section of the book, provides a succinct synopsis of a key study validating the Canadian C-spine rule for imaging the cervical spine in alert and stable trauma patients. This summary outlines the study methodology and design, major results, limitations and criticisms, related studies and additional information, and clinical implications. The study shows that the Canadian C-Spine Rule may be able to identify a large group of alert and stable adult trauma patients for whom cervical spine imaging is unnecessary. It may also help to standardize the appropriate use of cervical spine imaging in the emergency department. In addition to outlining the most salient features of the study, a clinical vignette and imaging example are included in order to provide relevant clinical context.

Detection of Cervical Spine Injuries in Alert, Asymptomatic Geriatric Blunt Trauma Patients: Who Benefits from Radiologic Imaging?

2006 ◽  
Vol 72 (9) ◽  
pp. 773-777 ◽  
Author(s):  
Adrian W. Ong ◽  
Aurelio Rodriguez ◽  
Robert Kelly ◽  
Vicente Cortes ◽  
Jack Protetch ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Cervical Spine ◽  
Blunt Trauma ◽  
Cervical Spine Injury ◽  
Motor Vehicle ◽  
Spine Injury ◽  
Trauma Patients ◽  
Cervical Spine Injuries ◽  
Spine Injuries ◽  
Anatomic Locations

There are differing recommendations in the literature regarding cervical spine imaging in alert, asymptomatic geriatric patients. Previous studies also have not used computed tomography routinely. Given that cervical radiographs may miss up to 60 per cent of fractures, the incidence of cervical spine injuries in this population and its implications for clinical management are unclear. We conducted a retrospective study of blunt trauma patients 65 years and older who were alert, asymptomatic, hemodynamically stable, and had normal neurologic examinations. For inclusion, patients were required to have undergone computed tomography and plain radiographs. The presence and anatomic location of potentially distracting injuries or pain were recorded. Two hundred seventy-four patients were included, with a mean age of 76 ± 10 years. The main mechanisms of injury were falls (51%) and motor vehicle crashes (41%). Nine of 274 (3%) patients had cervical spine injuries. The presence of potentially distracting injuries above the clavicles was associated with cervical injury when compared with patients with distracting injuries in other anatomic locations or no distracting injuries (8/115 vs 1/159, P = 0.03). There was no association of cervical spine injury with age greater or less than 75 years or with mechanism of injury. The overall incidence of cervical spine injury in the alert, asymptomatic geriatric population is low. The risk is increased with a potentially distracting injury above the clavicles. Patients with distracting injuries in other anatomic locations or no distracting injuries may not need routine cervical imaging.

Computed Tomography versus Magnetic Resonance Imaging for Evaluation of the Cervical Spine: How Many Slices do you Need?

2010 ◽  
Vol 76 (4) ◽  
pp. 365-368 ◽  
Author(s):  
Carlos V.R. Brown ◽  
Kelli H. Foulkrod ◽  
Andrew Reifsnyder ◽  
Eric Bui ◽  
Irene Lopez ◽  
...  
Keyword(s):  
Cervical Spine ◽  
Blunt Trauma ◽  
Injury Rate ◽  
Trauma Patients ◽  
Cervical Spine Injuries ◽  
Missed Injury ◽  
Spine Injuries ◽  
Ct Scanners ◽  
Clinically Significant ◽  
Ct And Mri

Controversy exists regarding the correlation between CT and MRI for evaluation of the cervical spine. We hypothesize that newer-generation CT scanners will improve diagnostic accuracy and may obviate the need for MRI in patients with a normal CT. We compared the missed injury rate of four-slice CT and 64-slice CT performed to evaluate the cervical spine. We conducted a retrospective study from January 2004 to June 2008 of all blunt trauma patients who underwent both a CT and MRI to evaluate the cervical spine. One hundred six blunt trauma patients underwent both CT and MRI, including 43 with four-slice and 63 with 64-slice CT. CT missed three injuries (3%), all of which were clinically significant ligamentous injuries seen only on MRI. The 64-slice CT missed no injuries (0%), whereas the four-slice CT missed all three (7%) of the ligamentous injuries ( P = 0.03). Older-generation CT scanners miss clinically significant injuries in blunt trauma patients and should not be independently relied on to evaluate the cervical spine. The newer 64-slice CT scan does not appear to miss clinically significant cervical spine injuries and may allow clearance of the cervical spine in blunt trauma patients without the addition of an MRI.

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.

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