Comparative Effectiveness of Computed Tomography Alone to Exclude Cervical Spine Injuries in Obtunded or Intubated Patients: A Meta-Analysis of 14 327 Blunt Trauma Patients

Neurosurgery ◽  
2010 ◽  
Vol 67 (2) ◽  
pp. 547-547
Author(s):  
Nestor Denys Tomycz ◽  
David M. Panczykowski ◽  
David O. Okonkwo
Keyword(s):  
Computed Tomography ◽  
Cervical Spine ◽  
Blunt Trauma ◽  
Comparative Effectiveness ◽  
Meta Analysis ◽  
Trauma Patients ◽  
Cervical Spine Injuries ◽  
Spine Injuries

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.

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.

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.

Delay in clearing cervical spine injuries in obtunded trauma patients and its implications

Trauma ◽  
2017 ◽  
Vol 20 (4) ◽  
pp. 273-280
Author(s):  
Kamaljit K Parmar ◽  
Kwok M Ho ◽  
Timothy Bowles
Keyword(s):  
Computed Tomography ◽  
Cervical Spine ◽  
Weekend Effect ◽  
Spine Injury ◽  
Trauma Patients ◽  
Prospective Audit ◽  
Cervical Spine Injuries ◽  
Increased Risk ◽  
Spine Injuries ◽  
Injury Status

Introduction Prompt recognition of cervical spine injuries may limit spinal cord damage. This prospective audit assessed the time needed to formally confirm the status of cervical spine using a computed tomography scan, the reasons for any delays, and the subsequent outcomes. Methodology Prospective audit analysed the data of 100 consecutive unconscious trauma patients, admitted over a seven-month period, to ascertain whether there was a ‘weekend’ effect in validating the cervical spine status radiologically, and whether the delays were associated with an increased risk of pneumonia and other complications. The sensitivity and specificity of using bony fractures and mal-alignment on the computed tomography scans to diagnose cervical spine injuries were calculated. Results Significant radiological evidence of cervical spine injuries occurred in 37 patients (37%). A delay in >48 h to ascertain the cervical spine status occurred in 36 patients, mostly due to logistical (58%) reasons, and this was associated with an increased risk of pneumonia requiring antibiotics (p < 0.001). A ‘weekend’ effect and presence of cervical spine injuries were not significantly related to the time to confirm the cervical spine injury status radiologically. The specificity (98%) of using bony fractures and mal-alignment on the computed tomography to diagnose cervical spine injuries was high, but its sensitivity (83.8%) was only modest. Conclusions A delay to confirm the cervical spine injury status was common and associated with an increased risk of pneumonia in unconscious trauma patients, particularly among those who did not sustain any cervical spine injuries. The low sensitivity of computed tomography to exclude non-bony cervical spine injuries suggests that selective early use of magnetic resonance imaging scans for high-risk unconscious trauma patients may improve patient outcomes.

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