Cervical Spine Clearance in Blunt Trauma: Evaluation of a Computed Tomography???Based Protocol

Abstract

The use of the authors' protocol resulted in excellent sensitivity and specificity in detecting cervical spine injuries. In addition, it allowed early removal of spinal precautions.

Comparison of Low-Dose With Standard-Dose Multidetector CT in Cervical Spine Trauma

“…22 Subsequently, CT should be the initial screening test in those patients, especially when there is a significantly depressed mental status. 22 This has been shown in multiple recent studies [3][4][5][6][7][8][9][10] : plain radiographs need not to be obtained in those patients, and the Eastern Association for the Surgery of Trauma guidelines 24,25 for cervical spine evaluation of blunt cervical spine trauma should be updated to reflect this evolving practice pattern. 6 Clinical evaluation of the neck can reliably rule out significant CSI in the awake and alert blunt trauma patients, so they do not need imaging.…”

“…The optimal imaging protocol for cervical spine clearance in patients with blunt trauma, especially in unconscious patients with traumatic brain injury, remains controversial. [2][3][4][5][6][7][8][9][10]22 With the proliferation of helical and MDCT, it became clear how poor standard radiography can be for the assessment of cervical spine fractures compared with CT. In a meta-analysis, the percentage of missed fractures on radiography versus CT was found between 1.5% and 52.0%, 22 whereby it is accepted that 10%-20% of significant CSIs are missed by using radiographs.…”

“…2 Multiple recent studies add to a growing body of evidence that MDCT should replace standard radiography in patients with blunt trauma who require radiographic evaluation of the cervical spine and in unconscious patients with severe head trauma, whereby standard radiography becomes unnecessary. [3][4][5][6][7][8][9][10] But only a small number of these patients will have a significant cervical spine injury (CSI): there is only a 2%-6% incidence of significant cervical spinal injury in the symptomatic population after acute trauma. 2,11,12 Therefore, most of these patients, many being young and otherwise healthy persons, will undergo a much larger radiation dose for their cervical spine clearance.…”

Hidden discoligamentous instability in cervical spine injuries: can quantitative motion analysis improve detection?

“…The false-negative rate for secondary MRI to detect discoligamentous injuries where the initial CT scan was negative was reported to be up to 25 % [8-10, 24, 25]. Several studies have addressed secondary MRI findings when the initial CT scan did not identify cervical instability [8][9][10]26]. A meta-analysis of Schoenfeld [27] including 1,550 patients found injuries in 6 % initially undetected on CT or radiography, but later detected by MRI altering treatment.…”

Prognostic value of heat shock protein (HSP) levels in patients with severe trauma and in critically ill patients

“…Međutim danas je uloga CT-a izuzetno važna u urgentnim prijemima i bez nje adekvatna evaluacija traumatizovanih pacijenata ne bi bila moguća. CT dijagnostika je zlatni standard dijagnostike za politraumatizovane pacijenta (Sanchez, 2005, Subramanian, 2007, Vercruysse, 2008). …”