Cervical spine clearance in obtunded blunt trauma patients: A prospective study

Deirdre Hennessy, Sandy Widder, David Zygun, R. John Hurlbert, Paul Burrowes, John B. Kortbeek

Research output: Contribution to journalArticle

38 Scopus citations

Abstract

BACKGROUND: An acceptable algorithm for clearance of the cervical spine (C-spine) in the obtunded trauma patient remains controversial. Undetected C-spine injuries of an unstable nature can have devastating consequences. This has led to reluctance toward C-spine clearance in these patients. OBJECTIVE: To objectify the accuracy of computed tomography (CT) scanning compared with dynamic radiographs within a well established C-spine clearance protocol in obtunded trauma patients at a level I trauma center. METHODS: This was a prospective study of consecutive blunt trauma patients (18 years or older) admitted to a single institution between December 2004 and April 2008. To be eligible for study inclusion, patients must have undergone both a CT scan and dynamic plain radiographs of their C-spine as a part of their clearance process. RESULTS: Among 402 patients, there was one injury missed on CT but detected by dynamic radiographs. This resulted in a percentage of missed injury of 0.25%. Subsequent independent review of the CT scan revealed that in fact pathologic changes were present on the scan indicative of the injury. CONCLUSIONS: Our results indicate that CT of the C-spine is highly sensitive in detecting the vast majority (99.75%) of clinically significant C-spine injuries. We recommend that CT be used as the sole modality to radiographically clear the C-spine in obtunded trauma patients and do not support the use of flexion-extension radiographs as an ancillary diagnostic method.

Original languageEnglish (US)
Pages (from-to)576-582
Number of pages7
JournalJournal of Trauma - Injury, Infection and Critical Care
Volume68
Issue number3
DOIs
StatePublished - Mar 1 2010
Externally publishedYes

Keywords

  • CT scanning
  • Cervical spine clearance
  • Cervical spine injury
  • Dynamic radiographs
  • Obtunded patients

ASJC Scopus subject areas

  • Surgery
  • Critical Care and Intensive Care Medicine

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