Faculty Collaboration Database

Additional Imaging in Alert Trauma Patients with Cervical Spine Tenderness and a Negative Computed Tomographic Scan: Is it Needed? World J Surg 2015 Nov;39(11):2685-90

Date

08/05/2015

Pubmed ID

26239776

DOI

10.1007/s00268-015-3182-6

Scopus ID

2-s2.0-84942983606 (requires institutional sign-in at Scopus site)   7 Citations

Abstract

BACKGROUND: The value of additional imaging in clearing the cervical spine (C-spine) of alert trauma patients with tenderness on clinical exam and a negative computed tomographic (CT) scan is still unclear.

METHODS: All adult trauma patients with a Glasgow Coma Scale of 15, C-spine tenderness in the absence of neurologic signs, and a negative C-spine CT were included. The study period extended from September 2011 to June 2012. C-spine CT scans were interpreted in detail and considered negative in the absence of any findings indicating bony, ligamentous, or soft tissue injury around the C-spine. The incidence of C-spine injury was evaluated using early (<24 h) repeat physical examination, MRI, and/or flexion-extension films.

RESULTS: Of 2015 patients with a C-spine CT, 383 (19 %) fulfilled the inclusion criteria. The median age was 43 (IQR: 30-53) and 44.7 % were female. Thirty-six patients (9.4 %) underwent MRI (3.7 %), flexion-extension imaging (5.2 %), or both (0.5 %), with no significant injuries identified and subsequent removal of the collar allowed. The remaining patients were clinically cleared within 24 h of presentation. None of the patients developed neurological signs following removal of the collar. On bivariate analysis, no variable except for evaluation by trauma surgery was associated with performance of additional imaging.

CONCLUSION: C-spine precautions can be withdrawn without additional imaging in most blunt trauma patients with C-spine tenderness but negative neurologic evaluation and C-spine CT. Focus should be placed on the detailed and comprehensive interpretation of the C-spine CT.

Author List

Mavros MN, Kaafarani HM, Mejaddam AY, Ramly EP, Avery L, Fagenholz PJ, Yeh DD, de Moya MA, Velmahos GC

Author

Marc Anthony De Moya MD Chief, Professor in the Surgery department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Adult
Cervical Vertebrae
Female
Glasgow Coma Scale
Humans
Magnetic Resonance Imaging
Male
Middle Aged
Spinal Injuries
Tomography, X-Ray Computed