Cervical spine MRI in patients with negative CT

Maung, Adrian A.; Johnson, Dirk C.; Barre, Kimberly; Peponis, Thomas; Mesar, Tomaž; Velmahos, George C.; McGrail, Daniel; Kasotakis, George; Gross, R; Rosenblatt, Michael S.; Sihler, Kristen C.; Winchell, Robert J.; Cholewczynski, Walter; Butler, Kathryn L.; Odom, Stephen R.; Davis, Kimberly A.

doi:10.1097/ta.0000000000001322

Cited by 35 publications

(9 citation statements)

References 13 publications

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“…Comparative multicenter prospective studies were able to show in a selected patient population that MRI examination identified additional pathological findings in 23.6 % of cases with inconspicuous CT examination of the cervical spine. However, they did not evaluate the clinical significance of the injuries 28 . However, at present, continuous availability of MRI examination is not specified as a requirement for trauma centers in the current White Book on Medical Care of the Severely Injured 9 .…”

Section: Discussionmentioning

confidence: 99%

“…Prinzipiell wird eine MRT-Untersuchung bei fraglichen CT-Befunden, wie etwa der traumatischen Dissektion von Vertebralarterien oder Pathologien der Wirbelsäule im Sinne einer Rückenmarksschädigung angefordert. Vergleichende multizentrische prospektive Studien konnten in einer selektionierten Patientenpopulation nachweisen, dass durch eine MRT in 23,6 % der Fälle bei unauffälligem CT der Halswirbelsäule zusätzliche pathologische Befunde entdeckt wurden, ohne die klinische Signifikanz der Verletzungen zu evaluieren 28 . Gegenwärtig ist das Vorhalten von MRT-Untersuchungen zu jeder Tageszeit jedoch keine Bedingung, die im aktuellen Weißbuch der Schwerverletztenversorgung als Anforderung für TraumaZentren vorgeschrieben ist 9 .…”

Section: Diskussionunclassified

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Structural and Process Data on Radiological Imaging in the Treatment of Severely Injured Patients – Results of a Survey of Level I and II Trauma Centers in Germany

Ernstberger

Reske²,

Brandl

et al. 2021

Rofo

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Purpose Systematic data collection regarding the integration of radiology as well as structural and process characteristics of radiological diagnostics of severely injured patients in Germany using a structured questionnaire. Materials and Methods Personal contact with all certified Level I and Level II Trauma Centers in Germany. Data on infrastructure, composition of the trauma room team, equipment, and data on the organization/performance of primary major trauma diagnostics were collected. Results With a participation rate of 46.9 % (n = 151) of all German trauma centers (N = 322), a solid database is available. There were highly significant differences in the structural characteristics incl. CT equipment between the level I and II centers: In 63.8 % of the level II centers, the CT unit was located more than 50 m away from the trauma room (34.2 % in the level I centers). A radiologist was part of the trauma room team in 59.5 % of level II centers (level I 88.1 %). Additionally, highly significant differences were found comparing 24-h provision of other radiologic examinations and interventions, such as MRI (level II 44.9 %, level I 92.8 %) and angiography (level II 69.2 %, level I 97.1 %). Conclusion Heterogeneous structural and process characteristics of the diagnosis of severely injured patients in Germany were revealed, with highly significant differences between level I and level II centers. Key Points: Citation Format

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Section: Discussionmentioning

confidence: 99%

Section: Diskussionunclassified

Structural and Process Data on Radiological Imaging in the Treatment of Severely Injured Patients – Results of a Survey of Level I and II Trauma Centers in Germany

Ernstberger

Reske²,

Brandl

et al. 2021

Rofo

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“…However, in the obtunded or unreliable patient, further MRI imaging may be warranted because of a limited clinical examination. 29…”

Section: Computed Tomography (Ct)/magnetic Resonance Imaging (Mri)mentioning

confidence: 99%

“…The ReCONECT trial by Maung and colleagues showed that in awake, oriented patients with a negative CT, MRI imaging failed to alter treatment course from nonoperative to operative management. However, in the obtunded or unreliable patient, further MRI imaging may be warranted because of a limited clinical examination 29…”

Section: Radiographic Evaluationmentioning

confidence: 99%

Management of Acute Subaxial Trauma and Spinal Cord Injury in Professional Collision Athletes

Patel

Divi

Canseco

et al. 2021

Clinical Spine Surgery: A Spine Publication

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Sports-related acute cervical trauma and spinal cord injury (SCI) represent a rare but devastating potential complication of collision sport injuries. Currently, there is debate on appropriate management protocols and return-to-play guidelines in professional collision athletes following cervical trauma. While cervical muscle strains and sprains are among the most common injuries sustained by collision athletes, the life-changing effects of severe neurological sequelae (ie, quadriplegia and paraplegia) from fractures and SCIs require increased attention and care. Appropriate on-field management and subsequent transfer/workup at an experienced trauma/SCI center is necessary for optimal patient care, prevention of injury exacerbation, and improvement in outcomes. This review discusses the epidemiology, pathophysiology, clinical presentation, immediate/long-term management, and current return-to-play recommendations of athletes who suffer cervical trauma and SCI.

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“…However, trauma patients may often fail to meet one or more requirements needed to remove the cervical collar (c-collar) as, for example, both guidelines require a normal level of alertness. In these NEXUS-positive patients, further examination will involve computed tomography (CT), and it is generally accepted that a c-collar can be removed following a negative CT of the cervical spine (CTCS) if no neurological deficits are apparent [3][4][5]. The evidence supporting this practice, however, is purely observational [6].…”

Section: Introductionmentioning

confidence: 99%

Cervical Spine Clearance in Trauma Patients with an Unreliable Physical Examination

et al. 2019

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Background The objective of this study was to describe and compare the timing of cervical spine clearance in trauma patients with an unreliable physical examination. Methods We prospectively included adult trauma patients admitted with a cervical collar and an unreliable clinical examination (as defined by the NEXUS criteria) at two level 1 trauma centers: one in the USA (US) and one in Denmark (DK). We excluded patients with cervical spine injuries requiring a collar or surgery as treatment and patients with a collar placed after hospital arrival. The primary outcome was time from emergency department (ED) arrival to collar removal. Secondary outcomes included time to CT of the cervical spine (CTCS). At the US trauma center, an institutional protocol allowing cervical spine clearance exclusively by CTCS was in place. At the Danish trauma center, cervical spine clearance was based on a clinical evaluation by an orthopedic surgeon, usually after CTCS.Results A total of 113 patients were included (US: n = 56; DK: n = 57). The median age was 47 years, and 68% were males. The main reasons for an unreliable physical examination were a Glasgow Coma Scale score below 14 (35%), distracting injuries (26%), cervical spine tenderness (13%) and intoxication (13%). The injury severity score at the US trauma center was higher than at the DK trauma center (median: 17 vs. 11, p = 0.03). Both time to CTCS (median: 41 vs. 18 min, p \ 0.0001) and time to collar removal (median: 1042 vs. 49 min, p \ 0.0001) were significantly greater at the US trauma center. Conclusions Time to collar removal was significantly greater in a trauma center utilizing a cervical spine clearance protocol based on CTCS. As patients may develop complications related to the collar, future studies should clarify how early removal can be implemented without increasing the risk of morbidity.

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Cervical spine MRI in patients with negative CT

Abstract: Therapeutic study, level IV.

Cited by 35 publications

References 13 publications

Structural and Process Data on Radiological Imaging in the Treatment of Severely Injured Patients – Results of a Survey of Level I and II Trauma Centers in Germany

Structural and Process Data on Radiological Imaging in the Treatment of Severely Injured Patients – Results of a Survey of Level I and II Trauma Centers in Germany

Management of Acute Subaxial Trauma and Spinal Cord Injury in Professional Collision Athletes

Cervical Spine Clearance in Trauma Patients with an Unreliable Physical Examination

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