Helical Computed Tomography Alone Compared with Plain Radiographs with Adjunct Computed Tomography to Evaluate the Cervical Spine After High-Energy Trauma

McCulloch, Patrick T.; Jones, Dina L.; Krantz, William A.; Nguyen, Thuan-Phuong; CHAMBERS, CRAIG; DORCHAK, JOE; Mucha, Peter

doi:10.2106/jbjs.e.00208

Cited by 77 publications

(40 citation statements)

References 18 publications

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“…Eight studies suggest that CT scan outperformed plain radiograph in patients with cervical trauma and recommended CT scan as first imaging for obtunded, highrisk, and/or multi-injured blunt trauma patients. 10,[24][25][26][27][28][29][30] These criteria include elements of inspection (alertness, intoxication, and movement), active range of motion (rotation), passive range of motion, palpation (midline tenderness), and additional screening (Glasgow Coma Scale). Two other studies using other criteria for radiography screening for high-risk cervical spine injury were scientifically admissible but had lower accuracy and predictability of serious cervical spine injury in adults.…”

Section: Sectionmentioning

confidence: 99%

Assessment of Neck Pain and Its Associated Disorders

Nordin

Carragee

Hogg‐Johnson

et al. 2009

Journal of Manipulative and Physiological Therapeutics

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Section: Sectionmentioning

confidence: 99%

Assessment of Neck Pain and Its Associated Disorders

Nordin

Carragee

Hogg‐Johnson

et al. 2009

Journal of Manipulative and Physiological Therapeutics

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“…Scattered studies of CSI in clinical series composed of all trauma patients report CSI prevalences ranging from 1 to 14%. 59,87 However, unevaluable patients require a higher index of suspicion than the general trauma population, 5,46,51,64,80,96 with one patient series estimating that a GCS score ≤ 8 incurs an almost 6-fold increase in the risk of CSI.…”

mentioning

confidence: 99%

Prevalence of cervical spinal injury in trauma

Milby

Halpern

Guo

et al. 2008

FOC

117

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Object Diagnosis of cervical spinal injury (CSI) is an essential aspect of the trauma evaluation. This task is especially difficult in patients who are not clinically able to be evaluated (unevaluable) because of distracting painful injuries, intoxication, or concomitant head injury. For this population, the appropriate use of advanced imaging techniques for cervical spinal clearance remains undetermined. This study was undertaken to estimate the prevalence of unstable CSI, particularly among patients in whom clinical evaluation is impossible or unreliable. Methods Estimates of the prevalence of CSI in populations consisting of all trauma patients, alert patients only, and clinically unevaluable patients only were determined by variance-weighted pooling of data from 65 publications (281,864 patients) that met criteria for review. Results The overall prevalence of CSI among all trauma patients was 3.7%. The prevalence of CSI in alert patients was 2.8%, whereas unevaluable patients were at increased risk of CSI with a prevalence of 7.7% (p = 0.007). Overall, 41.9% of all CSI cases were considered to exhibit instability. Conclusions Trauma patients who are clinically unevaluable have a higher prevalence of CSI than alert patients. Knowledge of the prevalence and risk of such injuries may help establish an evidence-based approach to the detection and management of clinically occult CSI.

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“…Certaines études, appliquant la règle NEXUS [2], semblent démontrer que cet examen pourrait remplacer la radiographie standard en première intention [12], souvent de qualité médiocre [13], mais la disponibilité de cet examen et son coût en limitent l'indication. Quand le risque est élevé, chez le patient polytraumatisé ou inconscient, le traumatisé crânien sévère, en cas de cinétique élevée, il sera effectué en première intention.…”

Section: Discussionunclassified