Prospective evaluation of computed tomographic scanning for the spinal clearance of obtunded trauma patients: preliminary results.

BACKGROUND Screening methods for detecting cervical spine injury in obtunded ventilated patients continue to evolve. This study compared the use of plain radiography to computed tomographic (CT) scanning of cervical spines in the obtunded blunt trauma patient. The accuracy of plain radiography and CT scanning in detecting clinically significant cervical spine injury in the obtunded blunt trauma patient was evaluated. METHODS We conducted a prospective cohort study with a 3-year convenience sample. The study population consisted of a high-risk subpopulation of severely injured patients, intubated or with a Glasgow Coma Scale score < 9 at presentation. Patients were assessed with a three-view cervical spine series and a CT scan of their cervical spines from the skull base to T1. Independent-blinded review of plain radiographs and CT scans was performed by two radiologists. Sensitivity, specificity, and accuracy of plain films were compared with CT scanning. Sensitivity of CT scanning was compared with discharge diagnosis of cervical spine or cord injury. RESULTS One hundred two patients were eligible and underwent three-view plain radiography and CT scanning. Sensitivity, specificity, and accuracy of plain films compared with CT scanning were 39%, 98%, and 88%, respectively. CT scanning was 100% sensitive in detecting cervical spine injury. CONCLUSION CT scanning in conjunction with plain films enhances the number of cervical spine injuries seen radiographically. Application of a protocol of plain radiographs and CT scanning may be used to clear cervical spines in the obtunded trauma patient. Ongoing evaluation of this protocol is required.

[1]  K. Linnau,et al.  Evidence-based approach to using CT in spinal trauma. , 2003, European journal of radiology.

[2]  L. Holly,et al.  Cervical spine trauma associated with moderate and severe head injury: incidence, risk factors, and injury characteristics. , 2002, Journal of neurosurgery.

[3]  T. Ryken,et al.  Clinical assessment after acute cervical spinal cord injury. , 2002, Neurosurgery.

[4]  J. Anglen,et al.  Flexion and extension views are not cost-effective in a cervical spine clearance protocol for obtunded trauma patients. , 2002, The Journal of trauma.

[5]  A Laupacis,et al.  The Canadian C-spine rule for radiography in alert and stable trauma patients. , 2001, JAMA.

[6]  K. Willett,et al.  Evaluation of the Oxford protocol for total spinal clearance in the unconscious trauma patient. , 2001, The Journal of trauma.

[7]  A. Wilson,et al.  Radiologic spectrum of craniocervical distraction injuries. , 2000, Radiographics : a review publication of the Radiological Society of North America, Inc.

[8]  G. Velmahos,et al.  Value of complete cervical helical computed tomographic scanning in identifying cervical spine injury in the unevaluable blunt trauma patient with multiple injuries: a prospective study. , 1999, The Journal of trauma.

[9]  E. Benzel,et al.  Magnetic resonance imaging evaluation of the cervical spine in the comatose or obtunded trauma patient. , 1999, Journal of neurosurgery.

[10]  R. Deyo,et al.  Cervical spine screening with CT in trauma patients: a cost-effectiveness analysis. , 1999, Radiology.

[11]  Sees Dw,et al.  The use of bedside fluoroscopy to evaluate the cervical spine in obtunded trauma patients , 1998 .

[12]  J R Hoffman,et al.  Selective cervical spine radiography in blunt trauma: methodology of the National Emergency X-Radiography Utilization Study (NEXUS). , 1998, Annals of emergency medicine.

[13]  K. Willett,et al.  'Clearance' of cervical spine injury in the obtunded patient. , 1998, Injury.

[14]  B. Blaylock,et al.  Trauma multidisciplinary QI project: evaluation of cervical spine clearance, collar selection, and skin care. , 1997, Journal of trauma nursing : the official journal of the Society of Trauma Nurses.

[15]  G. Velmahos,et al.  Radiographic cervical spine evaluation in the alert asymptomatic blunt trauma victim: much ado about nothing. , 1996, The Journal of trauma.

[16]  J. L. Williams,et al.  Clearing the cervical spine in obtunded patients: the use of dynamic fluoroscopy. , 1995, The Journal of trauma.

[17]  G. Schuierer,et al.  Substantial head trauma: value of routine CT examination of the cervicocranium. , 1995, Radiology.

[18]  M. Miller.  The role and limitations of computed tomographic scanning in the evaluation of cervical trauma: Woodring JH, Lee C J Trauma 33:698–708 Nov 1992 , 1993 .

[19]  J. Woodring,et al.  The role and limitations of computed tomographic scanning in the evaluation of cervical trauma. , 1992, The Journal of trauma.

[20]  L. Jacobs,et al.  A prospective analysis of a two-year experience using computed tomography as an adjunct for cervical spine clearance. , 1991, The Journal of trauma.

[21]  R. Knopp,et al.  Comparison of five-view and three-view cervical spine series in the evaluation of patients with cervical trauma. , 1989, Annals of emergency medicine.

[22]  S. Ross,et al.  Computed tomography in the initial evaluation of the cervical spine. , 1989, Annals of emergency medicine.

[23]  M. L. Richardson,et al.  High-resolution CT scanning in the evaluation of cervical spine fractures: comparison with plain film examinations. , 1987, AJR. American journal of roentgenology.

[24]  R. Knopp,et al.  Accuracy of standard radiographic views in detecting cervical spine fractures. , 1983, Annals of emergency medicine.

[25]  R. Knopp,et al.  Recommendations for evaluation of the acutely injured cervical spine: a clinical radiologic algorithm. , 1980, Annals of emergency medicine.