Prospective evaluation of multislice computed tomography versus plain radiographic cervical spine clearance in trauma patients

Reshma Mathen, Kenji Inaba, Felipe Munera, Pedro G R Teixeira, Luis Rivas, Mark McKenney, Peter Lopez, Carlos J. Ledezma

Research output: Contribution to journalArticle

78 Citations (Scopus)

Abstract

BACKGROUND: The objective of this study was to compare the utility of plain radiographs to multislice computed tomography (MCT) for cervical spine (c-spine) evaluation. We hypothesized that plain radiographs add no clinically relevant diagnostic information to MCT in the screening evaluation of the c-spine of trauma patients. METHODS: This was a prospective, unblinded, consecutive series of injured patients requiring c-spine evaluation that were imaged with three-view plain films and MCT (occiput to T1 with 3-dimensional reconstruction). The final discharge diagnosis based on all prospectively collected clinical data, MCT, and plain films was utilized as the gold standard for the sensitivity calculation. RESULTS: From October 2004 to February 2005, 667 trauma patients requiring c-spine evaluation were enrolled. Average age was 35.4 years and 70% were male. The mechanism of injury was blunt in 99% and 48.7% occurred as a result of motor vehicle collision. Sixty of 667 (9%) sustained acute c-spine injuries. MCT had a sensitivity of 100% and specificity of 99.5%. Plain films had a sensitivity of 45% and specificity of 97.4%. Plain radiography missed 15 of 27 (55.5%) clinically significant c-spine injuries. CONCLUSION: MCT outperformed plain radiography as a screening modality for the identification of acute c-spine injury in trauma patients. All clinically significant injuries were detected by MCT. Plain films failed to identify 55.5% of clinically significant fractures identified by MCT and added no clinically relevant information.

Original languageEnglish
Pages (from-to)1427-1431
Number of pages5
JournalJournal of Trauma - Injury, Infection and Critical Care
Volume62
Issue number6
DOIs
StatePublished - Jun 1 2007

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Multidetector Computed Tomography
Spine
Wounds and Injuries
Motion Pictures
Radiography
Sensitivity and Specificity
Nonpenetrating Wounds
Motor Vehicles

Keywords

  • Blunt
  • Cervical spine trauma
  • Injury
  • Trauma
  • Wounds and injuries

ASJC Scopus subject areas

  • Surgery

Cite this

Prospective evaluation of multislice computed tomography versus plain radiographic cervical spine clearance in trauma patients. / Mathen, Reshma; Inaba, Kenji; Munera, Felipe; Teixeira, Pedro G R; Rivas, Luis; McKenney, Mark; Lopez, Peter; Ledezma, Carlos J.

In: Journal of Trauma - Injury, Infection and Critical Care, Vol. 62, No. 6, 01.06.2007, p. 1427-1431.

Research output: Contribution to journalArticle

Mathen, Reshma ; Inaba, Kenji ; Munera, Felipe ; Teixeira, Pedro G R ; Rivas, Luis ; McKenney, Mark ; Lopez, Peter ; Ledezma, Carlos J. / Prospective evaluation of multislice computed tomography versus plain radiographic cervical spine clearance in trauma patients. In: Journal of Trauma - Injury, Infection and Critical Care. 2007 ; Vol. 62, No. 6. pp. 1427-1431.
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abstract = "BACKGROUND: The objective of this study was to compare the utility of plain radiographs to multislice computed tomography (MCT) for cervical spine (c-spine) evaluation. We hypothesized that plain radiographs add no clinically relevant diagnostic information to MCT in the screening evaluation of the c-spine of trauma patients. METHODS: This was a prospective, unblinded, consecutive series of injured patients requiring c-spine evaluation that were imaged with three-view plain films and MCT (occiput to T1 with 3-dimensional reconstruction). The final discharge diagnosis based on all prospectively collected clinical data, MCT, and plain films was utilized as the gold standard for the sensitivity calculation. RESULTS: From October 2004 to February 2005, 667 trauma patients requiring c-spine evaluation were enrolled. Average age was 35.4 years and 70{\%} were male. The mechanism of injury was blunt in 99{\%} and 48.7{\%} occurred as a result of motor vehicle collision. Sixty of 667 (9{\%}) sustained acute c-spine injuries. MCT had a sensitivity of 100{\%} and specificity of 99.5{\%}. Plain films had a sensitivity of 45{\%} and specificity of 97.4{\%}. Plain radiography missed 15 of 27 (55.5{\%}) clinically significant c-spine injuries. CONCLUSION: MCT outperformed plain radiography as a screening modality for the identification of acute c-spine injury in trauma patients. All clinically significant injuries were detected by MCT. Plain films failed to identify 55.5{\%} of clinically significant fractures identified by MCT and added no clinically relevant information.",
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AU - Rivas, Luis

AU - McKenney, Mark

AU - Lopez, Peter

AU - Ledezma, Carlos J.

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N2 - BACKGROUND: The objective of this study was to compare the utility of plain radiographs to multislice computed tomography (MCT) for cervical spine (c-spine) evaluation. We hypothesized that plain radiographs add no clinically relevant diagnostic information to MCT in the screening evaluation of the c-spine of trauma patients. METHODS: This was a prospective, unblinded, consecutive series of injured patients requiring c-spine evaluation that were imaged with three-view plain films and MCT (occiput to T1 with 3-dimensional reconstruction). The final discharge diagnosis based on all prospectively collected clinical data, MCT, and plain films was utilized as the gold standard for the sensitivity calculation. RESULTS: From October 2004 to February 2005, 667 trauma patients requiring c-spine evaluation were enrolled. Average age was 35.4 years and 70% were male. The mechanism of injury was blunt in 99% and 48.7% occurred as a result of motor vehicle collision. Sixty of 667 (9%) sustained acute c-spine injuries. MCT had a sensitivity of 100% and specificity of 99.5%. Plain films had a sensitivity of 45% and specificity of 97.4%. Plain radiography missed 15 of 27 (55.5%) clinically significant c-spine injuries. CONCLUSION: MCT outperformed plain radiography as a screening modality for the identification of acute c-spine injury in trauma patients. All clinically significant injuries were detected by MCT. Plain films failed to identify 55.5% of clinically significant fractures identified by MCT and added no clinically relevant information.

AB - BACKGROUND: The objective of this study was to compare the utility of plain radiographs to multislice computed tomography (MCT) for cervical spine (c-spine) evaluation. We hypothesized that plain radiographs add no clinically relevant diagnostic information to MCT in the screening evaluation of the c-spine of trauma patients. METHODS: This was a prospective, unblinded, consecutive series of injured patients requiring c-spine evaluation that were imaged with three-view plain films and MCT (occiput to T1 with 3-dimensional reconstruction). The final discharge diagnosis based on all prospectively collected clinical data, MCT, and plain films was utilized as the gold standard for the sensitivity calculation. RESULTS: From October 2004 to February 2005, 667 trauma patients requiring c-spine evaluation were enrolled. Average age was 35.4 years and 70% were male. The mechanism of injury was blunt in 99% and 48.7% occurred as a result of motor vehicle collision. Sixty of 667 (9%) sustained acute c-spine injuries. MCT had a sensitivity of 100% and specificity of 99.5%. Plain films had a sensitivity of 45% and specificity of 97.4%. Plain radiography missed 15 of 27 (55.5%) clinically significant c-spine injuries. CONCLUSION: MCT outperformed plain radiography as a screening modality for the identification of acute c-spine injury in trauma patients. All clinically significant injuries were detected by MCT. Plain films failed to identify 55.5% of clinically significant fractures identified by MCT and added no clinically relevant information.

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