Risks associated with magnetic resonance imaging and cervical collar in comatose, blunt trauma patients with negative comprehensive cervical spine computed tomography and no apparent spinal deficit

Dunham, C. Michael; Brocker, Brian P; Collier, Benjamin; Gemmel, David

doi:10.1186/cc6957

Cited by 73 publications

(58 citation statements)

References 119 publications

(144 reference statements)

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“…'normal CT' (variously described as needing prolonged collar application, halo vest or surgical stabilisation) varies from almost 0% [59],\1% [60], 2.5% [68] to approximately 4.3% as we have described above, among whom approximately 0.29% would require surgical stabilisation. This must be balanced however against the false positive rate with MRI, perhaps up to 25-40% [50], which if applied routinely would require all OBTPs to undergo prolonged stabilisation (with associated complications), even though 95% have no actual injury.…”

Section: Clearing the Thoracolumbar Spinementioning

confidence: 81%

See 1 more Smart Citation

Clinical review: spinal imaging for the adult obtunded blunt trauma patient: update from 2004

Plumb

Morris

2012

Intensive Care Med

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Section: Clearing the Thoracolumbar Spinementioning

confidence: 81%

“…Dunham et al [68] reviewed the risks of prolonged cervical collars and MRI scanning. They concluded that secondary brain injury was more likely than CS instability in OBTPs, and therefore advocated individualised risk assessments.…”

Section: Complications Of 'Spinal Precautions': Prolonged Immobilisatmentioning

confidence: 99%

Clinical review: spinal imaging for the adult obtunded blunt trauma patient: update from 2004

Plumb

Morris

2012

Intensive Care Med

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“…20 Although widely used, few data are available to guide this practice, 6 and adverse effects such as pressure sores, delirium, pneumonia, prolonged hospital and intensive care unit admissions, and increased intracranial pressure have been found to be more prevalent in this population. 10,21 Flexion-extension films and dynamic fluoroscopy have also been used for the assessment of ligamentous stability after negative initial imaging in the alert patient with persistent neck pain or in the obtunded patient. 22 In the unexaminable patient, flexionextension imaging has proved to be insensitive, 23 often inadequate, 24 cost ineffective, 25 potentially dangerous, 26 and unnecessary when CT has already been performed.…”

Section: Discussionmentioning

confidence: 99%

The daunting task of “clearing” the cervical spine

Grunau

Dibski

Hall

2012

CJEM

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The evaluation of the cervical spine in the emergency department is a common and often challenging task. We report the case of a 70-year-old female who presented intoxicated with evidence of a recent fall. A 64-slice computed tomographic (CT) scan with sagittal and coronal reconstructions revealed no acute injury. The patient was reexamined when alert and had persistent neck pain. Flexionextension static views revealed severe subluxation of C5 on C6 with jumped facets, and subsequent magnetic resonance imaging confirmed significant ligamentous injury. The evidence available suggests that although CT with reconstruction is highly sensitive for clinically significant cervical injury, the possibility of severe injury remains. RÉ SUMÉL'é valuation de la colonne cervicale au service des urgences est une tâ che courante et souvent difficile. Nous signalons le cas d'une femme de 70 ans qui s'est pré senté e aux urgences en é tat d'é brié té et portant des signes d'une chute ré cente. Un tomodensitogramme à 64 coupes par reconstruction frontale et sagittale n'a ré vé lé aucune lé sion aiguë . La patiente, une fois consciente, a é té ré examiné e et souffrait d'une douleur persistante au cou. Des cliché s statiques en flexion-extension ont ré vé lé une subluxation grave de C5 sur C6 et des facettes disloqué es, et un examen subsé quent d'imagerie par ré sonance magné tique (IRM) a confirmé une lé sion ligamentaire importante. Les donné es disponibles permettent de pré sumer que bien que la sensibilité du tomodensitogramme par reconstruction soit é levé e en cas de lé sion cervicale importante sur le plan clinique, la possibilité de lé sion grave demeure.

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“…11 However, recent findings from the EAST group in 2007 concluded that the risks associated with obtaining additional studies (such as MR imaging and flexion-extension radiographs under fluoroscopy) or with prolonged collar immobilization in a comatose, intubated patient (such as aspiration, elevated intracranial pressure, inadequate application of collar, and pressure sores) was substantially higher than the risk of missing an injury after a normal CT scan from the occiput to C-2 with sagittal and coronal reconstructions. 6 Importantly, these guidelines focused on adult patients. They cannot be applied to noncommunicative children because of the increased incidence of ligamentous injury in pediatric patients.…”

Section: 819mentioning

confidence: 99%

Utility of a cervical spine clearance protocol after trauma in children between 0 and 3 years of age

Anderson¹,

Kan²,

Vanaman³

et al. 2010

PED

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Object Cervical spine clearance after trauma in children 0–3 years of age is deceptively difficult. Young children may not be able to communicate effectively, and severe injuries may require intubation and sedation. Currently, no published guidelines are available to aid in decision-making in these complex situations. The purpose of this study was to determine whether a safe and effective protocol-driven system could be developed for clearance of the cervical spine in noncommunicative children between 0 and 3 years of age. Methods Children 0–3 years of age, including intubated patients, who were admitted after trauma activation at Primary Children's Medical Center in Salt Lake City or the Children's Hospital of New York from 2002 to 2006 were managed according to a cervical spine clearance protocol. Data were collected in a prospective fashion. Radiographic and clinical methods of clearing the cervical spine, as well as the type and management of injuries, were recorded. Results A total of 2828 pediatric trauma activations required cervical spine clearance during the study period. Of these, 575 (20%) were children ≤ 3 years of age who were admitted to the hospital. To facilitate clearing the cervical spine in these children, plain radiographs (100%), CT studies (14%), and MR images (10%) were obtained. Nineteen ligamentous injuries (3.3%) and 9 fractures/dislocations (1.5%) were detected, with 4 patients requiring operative stabilization (0.7%). No late injuries have been detected. Conclusions The protocol used has been effective in detecting cervical spine injuries in noncommunicative children after trauma. The combination of clinical information and radiographic studies is essential for safely clearing the cervical spine in these complex situations. Clearance of the cervical spine without CT or MR imaging studies is possible in the majority of cases, even in very young patients.

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Risks associated with magnetic resonance imaging and cervical collar in comatose, blunt trauma patients with negative comprehensive cervical spine computed tomography and no apparent spinal deficit

Cited by 73 publications

References 119 publications

Clinical review: spinal imaging for the adult obtunded blunt trauma patient: update from 2004

Clinical review: spinal imaging for the adult obtunded blunt trauma patient: update from 2004

The daunting task of “clearing” the cervical spine

Utility of a cervical spine clearance protocol after trauma in children between 0 and 3 years of age

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