A 2D threshold of the condylar–C1 interval to maximize identification of patients at high risk for atlantooccipital dislocation using computed tomography

OBJECTIVE Measurement of the occipital condyle–C1 interval (CCI) is important in the evaluation of atlantooccipital dislocation (AOD) in pediatric trauma patients. The authors studied a large cohort of children with and without AOD to identify a 2D measurement threshold that maximizes the diagnostic yield of the CCI on cervical spine CT scans obtained in trauma patients. METHODS This retrospective, single-center study included all children who underwent CT of the cervical spine at Primary Children's Hospital from January 1, 2011, through December 31, 2014, for trauma evaluation. Bilateral CCI measurements in the coronal (3 measurements per side) and sagittal (4 measurements per side) planes were recorded. Using an iterative method, the authors determined optimal cutoffs for the maximal CCI in each plane in relation to AOD. The primary outcome was AOD requiring occipitocervical fusion. RESULTS A total of 597 pediatric patients underwent cervical spine CT for trauma evaluation: 578 patients without AOD and 19 patients with AOD requiring occipitocervical fusion. The authors found a statistically significant correlation between CCI and age (p < 0.001), with younger patients having higher CCIs. Using a 2D threshold requiring a sagittal CCI ≥ 2.5 mm and a coronal CCI ≥ 3.5 mm predicted AOD with a sensitivity of 95%, a specificity of 73%, positive predictive value of 10.3%, and negative predictive value of 99%. The accuracy of this 2D threshold was 84%. CONCLUSIONS In the present study population, age-dependent differences in the CCI were found on CT scans of the cervical spine in a large cohort of patients with and without AOD. A 2D CCI threshold as a screening method maximizes identification of patients at high risk for AOD while minimizing unnecessary imaging studies in children being evaluated for trauma.

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Effectiveness of second-opinion radiology consultations to reassess the cervical spine CT scans: a study on trauma patients referred to a tertiary-care hospital

Diagnostic and Interventional Radiology ◽

10.5152/dir.2015.15003 ◽

2015 ◽

Vol 21 (5) ◽

pp. 423-427 ◽

Cited By ~ 11

Author(s):

Omid Khalilzadeh ◽

Maryam Rahimian ◽

Vinay Batchu ◽

Harshna V. Vadvala ◽

Robert A. Novelline ◽

...

Keyword(s):

Cervical Spine ◽

Tertiary Care Hospital ◽

Tertiary Care ◽

Second Opinion ◽

Ct Scans ◽

Trauma Patients ◽

Care Hospital ◽

Spine Ct

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Is Colour Doppler Ultrasound a Sensitive Screening Method in Diagnosing Deep Vein Thrombosis after Hip Surgery ?

Thrombosis and Haemostasis ◽

10.1055/s-0038-1650252 ◽

1996 ◽

Vol 75 (02) ◽

pp. 242-245 ◽

Cited By ~ 20

Author(s):

Marie Magnusson ◽

Bengt I Eriksson ◽

Peter Kãlebo ◽

Ramon Sivertsson

Keyword(s):

Deep Vein Thrombosis ◽

High Risk ◽

Doppler Ultrasound ◽

Predictive Value ◽

Screening Method ◽

Colour Doppler ◽

Vein Thrombosis ◽

Colour Doppler Ultrasound ◽

Asymptomatic Patients ◽

Deep Vein

SummaryPatients undergoing orthopedic surgery are at high risk of developing deep vein thrombosis. One hundred and thirty-eight consecutive patients undergoing total hip replacement or hip fracture surgery were included in this study. They were surveilled with colour Doppler ultrasound (CDU) and bilateral ascending contrast phlebography. The prevalence of proximal and distal DVT in this study was 5.8% and 20.3% respectively.CDU has a satisfactory sensitivity in patients with symptomatic deep vein thrombosis, especially in the proximal region. These results could not be confirmed in the present study of asymptomatic patients. The sensitivity was 62.5% (95% confidence interval: C.I. 24-91%) and the specificity 99.6% (C.I. 98-100%) for proximal DVT; 53.6% (C.I. 34-73%) and 98% (C.I. 96-99%) respectively for distal thrombi. The overall sensitivity was 58.1% (C.I. 39-75%) and the specificity 98% (C.I. 96-99%). The positive predictive value was 83.3% (C.I. 36-99%) and 75% (C.I. 51-91%) for proximal and distal DVT respectively. The negative predictive value was 98.9% (C.I. 98-100%) and 94.9% (C.I. 92-98%) for proximal and distal DVT respectively. The results of this study showed that even with a highly specialised and experienced investigator the sensitivity of CDU was too low to make it suitable for screening purposes in a high risk surgical population.

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Acute Traumatic Cervical Facet Fractures

Neurologico Spinale Medico Chirurgico ◽

10.15562/nsmc.v1i2.83 ◽

2018 ◽

Vol 1 (2) ◽

pp. 5

Author(s):

Shankar Gopinat

Keyword(s):

Spinal Cord ◽

Cervical Spine ◽

Early Surgery ◽

Initial Assessment ◽

Trauma Patients ◽

Spinal Stability ◽

Fracture Patterns ◽

Spine Ct ◽

Cervical Facet

Acute cervical facet fractures are increasingly being detected due to the use of cervical spine CT imaging in the initial assessment of trauma patients. For displaced cervical facet fractures with dislocations and subluxations, early surgery can decompress the spinal cord and stabilize the spine. For patients with non-displaced cervical facet fractures, the challenge in managing these patients is the determination of spinal stability. Although many of the patients with non-displaced cervical facet fractures can be managed with a cervical collar, the imaging needs to be analyzed carefully since certain fracture patterns may be better managed with early surgical stabilization.

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Can emergency physicians accurately rule out clinically important cervical spine injuries by using computed tomography?

CJEM ◽

10.2310/8000.2013.130978 ◽

2014 ◽

Vol 16 (02) ◽

pp. 131-135 ◽

Cited By ~ 3

Author(s):

Hendrik P. Van Zyl ◽

James Bilbey ◽

Alan Vukusic ◽

Todd Ring ◽

Jennifer Oakes ◽

...

Keyword(s):

Cervical Spine ◽

Cervical Spine Injury ◽

Clinical Skills ◽

Ct Scans ◽

Spine Injury ◽

Emergency Physicians ◽

Cervical Spine Injuries ◽

Spine Ct ◽

Spine Injuries ◽

Rule Out

ABSTRACT Objective: Emergency physicians are expected to rule out clinically important cervical spine injuries using clinical skills and imaging. Our objective was to determine whether emergency physicians could accurately rule out clinically important cervical spine injuries using computed tomographic (CT) imaging of the cervical spine. Method: Fifteen emergency physicians were enrolled to interpret a sample of 50 cervical spine CT scans in a nonclinical setting. The sample contained a 30% incidence of cervical spine injury. After a 2-hour review session, the participants interpreted the CT scans and categorized them into either a suspected cervical spine injury or no cervical spine injury. Participants were asked to specify the location and type of injury. The gold standard interpretation was the combined opinion of two staff radiologists. Results: Emergency physicians correctly identified 182 of the 210 abnormal cases with cervical spine injury. The sensitivity of emergency physicians was 87% (95% confidence interval [CI] 82–91), and the specificity was 76% (95% CI 74–77). The negative likelihood ratio was 0.18 (95% CI 0.12–0.25). Conclusion: Experienced emergency physicians successfully identified a large proportion of cervical spine injuries on CT; however, they were not sufficiently sensitive to accurately exclude clinically important injuries. Emergency physicians should rely on a radiologist review of cervical spine CT scans prior to discontinuing cervical spine precautions.

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Screening cervical spine MRI after normal cervical spine CT scans in patients in whom cervical spine injury cannot be excluded by physical examination

The American Journal of Surgery ◽

10.1016/j.amjsurg.2008.07.040 ◽

2008 ◽

Vol 196 (6) ◽

pp. 857-863 ◽

Cited By ~ 21

Author(s):

Megan Steigelman ◽

Peter Lopez ◽

Daniel Dent ◽

John Myers ◽

Michael Corneille ◽

...

Keyword(s):

Cervical Spine ◽

Physical Examination ◽

Cervical Spine Injury ◽

Ct Scans ◽

Spine Injury ◽

Spine Ct ◽

Spine Mri

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317 Cost-Effectiveness of a Novel Cervical Spine Clearance Protocol: Obviating the Need for Routine Magnetic Resonance Imaging

Neurosurgery ◽

10.1093/neuros/nyx417.317 ◽

2017 ◽

Vol 64 (CN_suppl_1) ◽

pp. 268-268

Author(s):

Jared Ament ◽

Bart Thaci ◽

Mena Said ◽

Ripul Rajen Panchal ◽

Kee Duk Kim ◽

...

Keyword(s):

Cervical Spine ◽

Cost Effectiveness ◽

Weight Bearing ◽

Ct Scans ◽

Spine Injury ◽

Trauma Patients ◽

Mri Findings ◽

Routine Magnetic Resonance Imaging ◽

Significant Difference ◽

Flexion Extension

Abstract INTRODUCTION Cervical spine injury (CSI) occurs in 2–4% of trauma patients in the USA causing significant decrements in quality of life and even death. Treatment of CSI is estimated to cost $9.7 billion annually. Computed tomography (CT) has an almost 100% negative predictive value (NPV) for cervical spine (c-spine) clearance, in both alert and obtunded patients. However, MRI can depict occult discoligamentous injury in some patients with negative CT scans. It remains unclear whether MRI findings should preclude c-spine clearance and prolong hospital stay. This review intends to critically assess CT-missed CSI patients and derive a safe, economically sustainable protocol for c-spine clearance. METHODS A retrospective review of prospectively collected CSI data from two, level-1 trauma centers, was conducted from 2015–2016. Primary outcome measures include: NPV and the incremental cost-effectiveness ratio (ICER) of a novel c-spine clearance protocol compared with standard of care. The protocol included thin-cut CT scans with either weight-bearing or flexion-extension films. The ICER was calculated using standard cost-utility analysis techniques in US dollars ($) per quality-adjusted-life-year (QALY), assuming a willingness-to-pay threshold of 50,000$/QALY. RESULTS >A total of 614 patients were reviewed. Mean age was 38.3 years (SD 18.6), 147 (23.9%) had altered mentation, and 12 (2%) had clinically meaningful CT-missed acute discoligamentous disruption. Our c-spine clearance protocol had a NPV of 99.8% (CI 96.5-100%). There was no statistically significant difference between awake and obtunded patients (P = 0.74). Mean time to c-spine clearance improved by 1.3 days (SD 0.9). Duration of c-spine immobilization was reduced by 930 person-days. Mean cost savings was $1230 (SD $242) per patient. Mean change in QALY was 0.02 (SD 0.01). The ICER was 61,500$/QALY. CONCLUSION Our novel CSI clearance protocol is both safe and highly cost-effective. It improves outcomes at less cost, making it a dominant strategy that centers should consider implementing.

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Utility of STIR MRI in pediatric cervical spine clearance after trauma

Journal of Neurosurgery Pediatrics ◽

10.3171/2013.4.peds12477 ◽

2013 ◽

Vol 12 (1) ◽

pp. 30-36 ◽

Cited By ~ 15

Author(s):

Mark Henry ◽

Katherine Scarlata ◽

Ron I. Riesenburger ◽

James Kryzanski ◽

Leslie Rideout ◽

...

Keyword(s):

Cervical Spine ◽

Predictive Value ◽

Motor Vehicle ◽

Motor Vehicle Accident ◽

Pediatric Trauma ◽

Outcome Data ◽

Trauma Patients ◽

Mri Studies ◽

The Mean

Object Although MRI with short-term T1 inversion recovery (STIR) sequencing has been widely adopted in the clearance of cervical spine in adults who have sustained trauma, its applicability for cervical spine clearance in pediatric trauma patients remains unclear. The authors sought to review a Level 1 trauma center's experience using MRI for posttraumatic evaluation of the cervical spine in pediatric patients. Methods A pediatric trauma database was retrospectively queried for patients who received an injury warranting radiographic imaging of the cervical spine and had a STIR-MRI sequence of the cervical spine performed within 48 hours of injury between 2002 and 2011. Demographic, radiographic, and outcome data were retrospectively collected through medical records. Results Seventy-three cases were included in the analysis. The mean duration of follow-up was 10 months (range 4 days–7 years). The mean age of the patients at the time of trauma evaluation was 8.3 ± 5.8 years, and 65% were male. The majority of patients were involved in a motor vehicle accident. In 70 cases, the results of MRI studies were negative, and the patients were cleared prior to discharge with no clinical suggestion of instability on follow-up. In 3 cases, the MRI studies had abnormal findings; 2 of these 3 patients were cleared with dynamic radiographs during the same admission. Only 1 patient had an unstable injury and required surgical stabilization. The sensitivity of STIR MRI to detect cervical instability was 100% with a specificity of 97%. The positive predictive value was 33% and the negative predictive value was 100%. Conclusions Although interpretation of our results are diminished by limitations of the study, in our series, STIR MRI in routine screening for pediatric cervical trauma had a high sensitivity and slightly lower specificity, but may have utility in future practices and should be considered for implementation into protocols.

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