Evaluation of acute cervical spine imaging based on ACR Appropriateness Criteria®

Abstract

The objectives of this study were to determine the rate of acute blunt cervical spine injury at an academic urban level 1 trauma center and to evaluate the utilization of cervical spine imaging based on the established American College of Radiology (ACR) Appropriateness Criteria®. We retrospectively reviewed all radiography and CT imaging of the cervical spine performed over a year period in adult patients presenting with acute blunt cervical spine trauma. Exclusion criteria were children ≤17 years, non-acute trauma of ≥72 h, and penetrating trauma. Any fracture, dislocation, or ligamentous instability demonstrated by diagnostic imaging and requiring stabilization or specialized follow-up was defined as clinically significant cervical spine injury. A total of 1,325 cervical spine studies were reviewed in 1,245 patients; 32.7% (433/1,325) were cervical spine radiographs and 67.3% (892/1,325) were CT examinations. Approximately 1.5% (19/1,245) of the patients demonstrated clinically significant acute cervical spine injury. There were 6.4% (80/1,245) patients who received both cervical spine radiographs and CT as imaging evaluation. Based on the ACR Appropriateness Criteria®, all of the cervical spine radiographs performed (433) were determined to be "inappropriate" imaging in the setting of acute cervical spine injury.

Omurga Acilleri

“…Oysa RG'lerin %98'inden fazlası negatif olup, toplam maliyet oldukça yüksektir [8]. Görüntüleme endikasyonu oldukça önemli olup, bu karar bilinci bozuk, yaşlı ve çocuk hastalarda daha zordur [2].…”

“…NEXUS ve CCR çalışmalarının birbirine karşı bir üstünlüğü yoktur [8]. Bunlara ve diğer çalışmalara dayanılarak "American College of Radiology Uygunluk Kriterleri (ACR-AC)" belirlenmiştir [8].…”

“…Bunlara ve diğer çalışmalara dayanılarak "American College of Radiology Uygunluk Kriterleri (ACR-AC)" belirlenmiştir [8]. Buna göre; akut servikal travmada yalnızca yüksek riskli grupta görün-tüleme yapılmalı, düşük risk grubu NEXUS ya da CCR'ye göre belirlenmelidir.…”

“…Kırık olmadan izole servikal ligament hasarı oldukça nadirdir (%0,04-0,6) [1,2]. Üstelik ağrı ve kas spazmına bağlı olguların %30'unda RG kalitesi yetersiz olup %12,5 olguda servikal yaralanma ile sonuçlandığı raporlanmıştır [1,8].…”

Reliability of the STIR Sequence for Acute Type II Odontoid Fractures

“…12 Currently, cervical spine trauma is most commonly evaluated with multidetector CT with sagittal and coronal reconstructions, which have improved delineation of fractures compared with plain radiographs. 13,14 There is an increasing role for MR imaging, with its superior soft-tissue resolution, in the acute setting in patients with neurologic injury not only to evaluate the spinal cord but also to define areas of ligamentous injury that may relate to clinical instability. Although the routine evaluation of MR imaging of the cervical spine involves careful review of all sequences, the STIR sequence is relied on to reveal marrow edema related to an acute fracture.…”