Sixty-four–slice computed tomographic scanner to clear traumatic cervical spine injury: Systematic review of the literature

Sixty-four-slice computed tomographic scan to clear cervical spine injury: Remember to examine the patient before clearing

“…Although we agree that it will be interesting to see what the literature shows regarding 64-slice (and newer) CT scans as time goes on, we disagree that it contradicts our conclusions. In fact, this study may support our assertion that certain patients with underlying spine pathology may not be able to be cleared using CT scan alone [2]. The patients in whom central cord syndrome was suspected, despite a negative CT scan had pre-existing spinal pathology, which we suggest should have precluded them from being cleared by CT alone due to the presence of a potential confounder.…”

“…The definition of "missed injury" used in our systematic review was injury resulting in a change in management (either maintenance of a CS collar or surgical intervention) [2]. We do agree with Dr Wu et al in that a full description of all missed injuries is needed in future studies on this topic; however, this was outside the scope of our systematic review.…”

“…The authors question whether 64-slice CT scanners allow for better detection of ligamentous or cord injury and reference one study by Brohi et al [9] into highlight that older-generation CT scanners may also have a high negative predictive value. We acknowledged this in Table 2 of our study, referencing several non-64-slice CT scanners where an MRI did not find any clinically significant injuries [2]. Despite a low rate of clinically significant injury with older-generation scanner, newer 64-slice scanners do provide higher spatial resolution and better granularity to assess for injury that may be associated with soft tissue or cord injury and thus potentially providing greater sensitivity.…”

“…We appreciate the opportunity to respond to their thoughtful comments and further expand upon our work [2].…”

Cervical spine collar clearance in the obtunded adult blunt trauma patient

“…At the qualitative synthesis level, 40 of 52 studies were excluded because of the following reasons: 2 were systematic reviews, 14,15 1 used survey data, 16 11 did not use C-spine CT as a distinct primary imaging modality, 17–27 13 failed to define or had 3 mm or greater axial CT thickness, 28–40 11 had an undefined or mixed obtunded and nonobtunded population, 26,41–50 and 2 were case reports. 51,52 As outlined in our PRISMA [Preferred Reporting Items for Systematic Reviews and Meta-Analyses] 53 diagram (Fig.…”