Sticking our neck out: Is magnetic resonance imaging needed to clear an obtunded patient's cervical spine?

Shevonne S. Satahoo, James S. Davis, George Garcia, Salman Alsafran, Reeni K. Pandya, Cheryl D. Richie, Fahim Habib, Luis Rivas, Nicholas Namias, Carl I Schulman

Research output: Contribution to journalArticle

9 Citations (Scopus)

Abstract

Background Evaluating the cervical spine in the obtunded trauma patient is a subject fraught with controversy. Some authors assert that a negative computed tomography (CT) scan is sufficient. Others argue that CT alone misses occult unstable injuries, and magnetic resonance imaging (MRI) will alter treatment. This study examines the data in an urban, county trauma center to determine if a negative cervical spine CT scan is sufficient to clear the obtunded trauma patient. Methods Records of all consecutive patients admitted to a level 1 trauma center from January 2000 to December 2011 were retrospectively analyzed. Patients directly admitted to the intensive care unit with a Glasgow Coma Scale score ≤13, contemporaneous CT and MRI, and a negative CT reading were included. The results of the cervical spine MRI were analyzed. Results A total of 309 patients had both CT and MRI, 107 (35%) of whom had negative CTs. Mean time between CT and MRI was 16 d. Of those patients, seven (7%) had positive acute traumatic findings on MRI. Findings included ligamentous injury, subluxation, and fracture. However, only two of these patients required surgical intervention. None had unstable injuries. Conclusions In the obtunded trauma patient with a negative cervical spine CT, obtaining an MRI does not appear to significantly alter management, and no unstable injuries were missed on CT scan. This should be taken into consideration given the current efforts at cost-containment in the health care system. It is one of the larger studies published to date.

Original languageEnglish
Pages (from-to)225-229
Number of pages5
JournalJournal of Surgical Research
Volume187
Issue number1
DOIs
StatePublished - Mar 1 2014

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Spine
Neck
Tomography
Magnetic Resonance Imaging
Wounds and Injuries
Trauma Centers
Glasgow Coma Scale
Cost Control
Intensive Care Units
Reading
Delivery of Health Care

Keywords

  • Cervical spine
  • CT
  • Imaging
  • MRI
  • Obtunded
  • Trauma

ASJC Scopus subject areas

  • Surgery

Cite this

Sticking our neck out : Is magnetic resonance imaging needed to clear an obtunded patient's cervical spine? / Satahoo, Shevonne S.; Davis, James S.; Garcia, George; Alsafran, Salman; Pandya, Reeni K.; Richie, Cheryl D.; Habib, Fahim; Rivas, Luis; Namias, Nicholas; Schulman, Carl I.

In: Journal of Surgical Research, Vol. 187, No. 1, 01.03.2014, p. 225-229.

Research output: Contribution to journalArticle

Satahoo, Shevonne S. ; Davis, James S. ; Garcia, George ; Alsafran, Salman ; Pandya, Reeni K. ; Richie, Cheryl D. ; Habib, Fahim ; Rivas, Luis ; Namias, Nicholas ; Schulman, Carl I. / Sticking our neck out : Is magnetic resonance imaging needed to clear an obtunded patient's cervical spine?. In: Journal of Surgical Research. 2014 ; Vol. 187, No. 1. pp. 225-229.
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abstract = "Background Evaluating the cervical spine in the obtunded trauma patient is a subject fraught with controversy. Some authors assert that a negative computed tomography (CT) scan is sufficient. Others argue that CT alone misses occult unstable injuries, and magnetic resonance imaging (MRI) will alter treatment. This study examines the data in an urban, county trauma center to determine if a negative cervical spine CT scan is sufficient to clear the obtunded trauma patient. Methods Records of all consecutive patients admitted to a level 1 trauma center from January 2000 to December 2011 were retrospectively analyzed. Patients directly admitted to the intensive care unit with a Glasgow Coma Scale score ≤13, contemporaneous CT and MRI, and a negative CT reading were included. The results of the cervical spine MRI were analyzed. Results A total of 309 patients had both CT and MRI, 107 (35{\%}) of whom had negative CTs. Mean time between CT and MRI was 16 d. Of those patients, seven (7{\%}) had positive acute traumatic findings on MRI. Findings included ligamentous injury, subluxation, and fracture. However, only two of these patients required surgical intervention. None had unstable injuries. Conclusions In the obtunded trauma patient with a negative cervical spine CT, obtaining an MRI does not appear to significantly alter management, and no unstable injuries were missed on CT scan. This should be taken into consideration given the current efforts at cost-containment in the health care system. It is one of the larger studies published to date.",
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