An Evidenced-Based Approach to Radiographic Assessment of Cervical Spine Injuries in the Emergency Department

Greenbaum, Jason A.; Walters, Nathan W.; Levy, Phillip D.

doi:10.1016/j.jemermed.2008.01.014

Cited by 27 publications

(15 citation statements)

References 59 publications

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“…1,2 Currently, emergency physicians assess the cervical spine of low-risk trauma patients by employing clinical judgment and using clinical decision rules (CDRs), such as the Canadian Cervical Spine Rule (CCSR) 3 and the NEXUS rule. 4 These CDRs are used to determine the need for x-ray imaging of the cervical spine.…”

Section: Ré Sumémentioning

confidence: 99%

Can emergency physicians accurately rule out clinically important cervical spine injuries by using computed tomography?

Zyl

Bilbey

Vukusic

et al. 2014

CJEM

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Objective: Emergency physicians are expected to rule out clinically important cervical spine injuries using clinical skills and imaging. Our objective was to determine whether emergency physicians could accurately rule out clinically important cervical spine injuries using computed tomographic (CT) imaging of the cervical spine. Method: Fifteen emergency physicians were enrolled to interpret a sample of 50 cervical spine CT scans in a nonclinical setting. The sample contained a 30% incidence of cervical spine injury. After a 2-hour review session, the participants interpreted the CT scans and categorized them into either a suspected cervical spine injury or no cervical spine injury. Participants were asked to specify the location and type of injury. The gold standard interpretation was the combined opinion of two staff radiologists. Results: Emergency physicians correctly identified 182 of the 210 abnormal cases with cervical spine injury. The sensitivity of emergency physicians was 87% (95% confidence interval [CI] 82-91), and the specificity was 76% (95% CI 74-77). The negative likelihood ratio was 0.18 (95% CI 0.12-0.25). Conclusion: Experienced emergency physicians successfully identified a large proportion of cervical spine injuries on CT; however, they were not sufficiently sensitive to accurately exclude clinically important injuries. Emergency physicians should rely on a radiologist review of cervical spine CT scans prior to discontinuing cervical spine precautions. RÉ SUMÉObjectif: Les urgentologues devraient ê tre en mesure d'é carter l'existence de lé sions, importantes sur le plan clinique, de la colonne cervicale en s'appuyant sur leurs compé tences cliniques et l'imagerie. L'é tude visait à dé terminer si les urgentologues pouvaient é carter correctement l'existence de lé sions, importantes sur le plan clinique, de la colonne cervicale sur le plan clinique à l'aide de l'imagerie par tomodensitomé trie de la colonne cervicale. Mé thode: Quinze urgentologues ont accepté d'interpré ter un é chantillon de 50 tomodensitogrammes (TDM) de la colonne cervicale en milieu non clinique; l'é chantillon comptait 30% de cas de lé sion de la colonne cervicale. Aprè s une sé ance de formation de 2 heures, les participants ont interpré té les TDM et les ont classé s en deux caté gories: lé sion possible et absence de lé sion. Les participants devaient pré ciser le siè ge des lé sions et leur type. L'interpré tation de ré fé rence reposait sur l'avis de deux radiologistes, membres du personnel. Ré sultats: Les urgentologues ont bien identifié 182 cas de lé sion de la colonne cervicale sur 210. La sensibilité des urgentologues é tait de 87% (intervalle de confiance [IC] à 95% 82-91) et la spé cificité de 76% (IC à 95% 74-77). Le quotient de vraisemblance né gatif s'est é tabli à 0.18 (IC à 95% 0.12-0.25). Conclusions: Les urgentologues expé rimenté s ont ré ussi à identifier, dans une grande proportion, les lé sions de la colonne cervicale sur les TDM; toutefois, la sensibilité n'é tait pas suffisamment é lev...

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Section: Ré Sumémentioning

confidence: 99%

Can emergency physicians accurately rule out clinically important cervical spine injuries by using computed tomography?

Zyl

Bilbey

Vukusic

et al. 2014

CJEM

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“…Falls, assault, penetrating and sports injuries form the remaining causes of spinal injury. The prevalence is likely to be significantly higher in patients with head trauma and those who are unconscious at presentation [2, 3]. The subaxial cervical spine (C3–C7) is particularly vulnerable to traumatic injury due to its considerable mobility and its close proximity to the more rigid thoracic spine.…”

Section: Introductionmentioning

confidence: 99%

MDCT of acute subaxial cervical spine trauma: a mechanism-based approach

et al. 2014

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Injuries to the spinal column are common and road traffic accidents are the commonest cause. Subaxial cervical spine (C3–C7) trauma encompasses a wide spectrum of osseous and ligamentous injuries, in addition to being frequently associated with neurological injury. Multidetector computed tomography (MDCT) is routinely performed to evaluate acute cervical spine trauma, very often as first-line imaging. MDCT provides an insight into the injury morphology, which in turn reflects the mechanics of injury. This article will review the fundamental biomechanical forces underlying the common subaxial spine injuries and resultant injury patterns or “fingerprints” on MDCT. This systematic and focused analysis enables a more accurate and rapid interpretation of cervical spine CT examinations. Mechanical considerations are important in most clinical and surgical decisions to adequately realign the spine, to prevent neurological deterioration and to facilitate appropriate stabilisation. This review will emphasise the variables on CT that affect the surgical management, as well as imaging “pearls” in differentiating “look-alike” lesions with different surgical implications. It will also enable the radiologist in writing clinically relevant CT reports of cervical spine trauma.Teaching Points• Vertebral bodies and disc bear the axial compression forces, while the ligaments bear the distraction forces.• Compressive forces result in fracture and distractive forces result in ligamentous disruption.• Bilateral facet dislocation is the most severe injury of the flexion-distraction spectrum.• Biomechanics-based CT reading will help to rapidly and accurately identify the entire spectrum of injury.• This approach also helps to differentiate look-alike injuries with different clinical implications.

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“…There is a difference in the prevalence of CSI after blunt trauma between adults and children, 2-6 and 1.5 %, respectively [17,18]. Several recent retrospective studies focusing on the pediatric population have found high sensitivities for plain radiography in the detection of CSI.…”

Section: Discussionmentioning

confidence: 99%

Sensitivity of plain radiography for pediatric cervical spine injury

Cui

Probst

Hoffman³

et al. 2016

Emerg Radiol

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Society of EmergencyAbstract Pediatric patients with suspected cervical spine injuries (CSI) often receive a computed tomography (CT) scan as an initial diagnostic imaging test. While sensitive, CT of the cervical spine carries significant radiation and risk of lethal malignant transformation later in life. Plain radiographs carry significantly less radiation and could serve as the preferred screening tool, provided they have a high functional sensitivity in detecting pediatric patients with CSI. We hypothesize that plain cervical spine radiographs can reliably detect pediatric patients with CSI and seek to quantify the functional sensitivity of plain radiography as compared to CT. We analyzed data from the NEXUS cervical spine study to assess the sensitivity of plain radiographs in the evaluation of CSI. We identified all pediatric patients who underwent plain radiographic imaging, and all pediatric patients found to have CSI. We then determined the sensitivity of plain radiographs in detecting pediatric patients with CSI. We identified 44 pediatric patients with CSI in the dataset with age ranging from 2 to 18 years old. Thirty-two of the 44 pediatric patients received cervical spine plain films as a part of their workup. Plain films were able to identify all 32 pediatric patients with CSI to yield a sensitivity of 100 % in detecting injury victims (95 % confidence interval 89.1-100.0 %). Plain radiography was highly sensitive for the identification of CSI in our cohort of pediatric patients and is useful as a screening tool in the evaluation of pediatric CSI.

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An Evidenced-Based Approach to Radiographic Assessment of Cervical Spine Injuries in the Emergency Department

Cited by 27 publications

References 59 publications

Can emergency physicians accurately rule out clinically important cervical spine injuries by using computed tomography?

Can emergency physicians accurately rule out clinically important cervical spine injuries by using computed tomography?

MDCT of acute subaxial cervical spine trauma: a mechanism-based approach

Sensitivity of plain radiography for pediatric cervical spine injury

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