Are Five-View Plain Films of the Cervical Spine Unreliable? A Prospective Evaluation in Blunt Trauma Patients with Altered Mental Status

Abstract

CTS outperformed five-view CSX in a group of patients with altered mental status or distracting injuries. Five-view CSX failed to diagnose 52.3% of cervical spine fractures identified by CTS. Five-view CSX failed to diagnose five patients with unstable cervical fractures and failed to identify 93.3% of patients with occipital condyle fractures.

Comparison of Low-Dose With Standard-Dose Multidetector CT in Cervical Spine Trauma

“…13 There are only a few studies that stress the attention on radiation exposure of CT in evaluation of patients with cervical spine trauma. 4,7,23 In a recent study, a very high mean effective dose of 26 mSv was reached with cervical spine helical CT, 4 which is approximately 80 -100 times higher than the radiation dose of a 5-film standard radiographic study (0.25-0.30 mSv). 21 Our study gives a much lower radiation exposure of approximately 4-mSv effective dose with the standard MDCT protocol with fixed tube current, which is approximately 16 times higher than for radiography.…”

“…22 Subsequently, CT should be the initial screening test in those patients, especially when there is a significantly depressed mental status. 22 This has been shown in multiple recent studies [3][4][5][6][7][8][9][10] : plain radiographs need not to be obtained in those patients, and the Eastern Association for the Surgery of Trauma guidelines 24,25 for cervical spine evaluation of blunt cervical spine trauma should be updated to reflect this evolving practice pattern. 6 Clinical evaluation of the neck can reliably rule out significant CSI in the awake and alert blunt trauma patients, so they do not need imaging.…”

“…The optimal imaging protocol for cervical spine clearance in patients with blunt trauma, especially in unconscious patients with traumatic brain injury, remains controversial. [2][3][4][5][6][7][8][9][10]22 With the proliferation of helical and MDCT, it became clear how poor standard radiography can be for the assessment of cervical spine fractures compared with CT. In a meta-analysis, the percentage of missed fractures on radiography versus CT was found between 1.5% and 52.0%, 22 whereby it is accepted that 10%-20% of significant CSIs are missed by using radiographs.…”

“…2 Multiple recent studies add to a growing body of evidence that MDCT should replace standard radiography in patients with blunt trauma who require radiographic evaluation of the cervical spine and in unconscious patients with severe head trauma, whereby standard radiography becomes unnecessary. [3][4][5][6][7][8][9][10] But only a small number of these patients will have a significant cervical spine injury (CSI): there is only a 2%-6% incidence of significant cervical spinal injury in the symptomatic population after acute trauma. 2,11,12 Therefore, most of these patients, many being young and otherwise healthy persons, will undergo a much larger radiation dose for their cervical spine clearance.…”

Missed injury in patients with severe traumatic brain injury complicated by multiple trauma

“…Pathological reflex and abnormal muscle tone or tendon reflexes, which cannot be explained by TBI, should be suspected from the existence of paralysis. Thus, CT scan of Co-C3, which is superior to plain films, should be conducted for the early detection of upper cervical spine injury (7,8,14). Therefore, in addition to the initial head scan, a CT scan of Co-C3 should be performed as part of the routine for patients suspected of neck injury.…”