Lumbar fractures in adult blunt trauma: Axial and single-slice helical abdominal and pelvic computed tomographic scans versus portable plain films

Peter M Rhee, Amy Bridgeman, Jose A. Acosta, Susan Kennedy, Dennis S Y Wang, J. Sarveswaran

Research output: Contribution to journalArticle

39 Citations (Scopus)

Abstract

Background: Our hypothesis was that abdominal and pelvic computed tomographic (AP-CT) scans are equivalent to portable two-view plain films in detecting lumbar spine fractures in adults. Since many trauma patients often undergo AP-CT scanning to evaluate for possible intra-abdominal injuries, using the AP-CT scan to screen for lumbar fractures could make the trauma evaluation process more efficient. Methods: The institutional trauma registry at a Level I trauma center was used to identify all blunt lumbar fractures during a 6-year period. Medical records were reviewed. Results: A total of 7,216 adult blunt trauma patients were evaluated, and 115 patients were identified as having a lumbar fracture, for an incidence rate of 1.6%. Missed fracture rates were high for both AP-CT scans (23.2%, 13 of 56) and portable two-view films (12.7%, 14 of 110, p = 0.08). Fifty-two patients had both AP-CT scans and plain films. In this group, AP-CT scans missed 23.1% (12 of 52) of the lumbar fractures and plain films missed 15.4% (8 of 52). However, the combination of the two diagnostic methods did not miss any fractures (0 of 52). The missed fractures required surgery or brace in 50% (7 of 14) patients who had fractures missed by plain films and 46% (6 of 13) patients whose fractures were missed by AP-CT scanning. Conclusion: Both AP-CT scans and plain films failed to diagnose significant lumbar fractures that required therapy. When screening for lumbar fractures, obtaining both AP-CT scans and portable two-view plain films may decrease missed lumbar fractures in blunt adult trauma.

Original languageEnglish (US)
Pages (from-to)663-667
Number of pages5
JournalJournal of Trauma
Volume53
Issue number4
StatePublished - Oct 1 2002
Externally publishedYes

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Wounds and Injuries
Abdominal Injuries
Braces
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Medical Records
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Spine
Incidence

Keywords

  • Abdominal
  • Computed tomographic scan
  • Lumbar fracture
  • Pelvic
  • Plain films
  • Radiographs
  • Spine fracture
  • Trauma
  • X-rays

ASJC Scopus subject areas

  • Surgery

Cite this

Lumbar fractures in adult blunt trauma : Axial and single-slice helical abdominal and pelvic computed tomographic scans versus portable plain films. / Rhee, Peter M; Bridgeman, Amy; Acosta, Jose A.; Kennedy, Susan; Wang, Dennis S Y; Sarveswaran, J.

In: Journal of Trauma, Vol. 53, No. 4, 01.10.2002, p. 663-667.

Research output: Contribution to journalArticle

Rhee, Peter M ; Bridgeman, Amy ; Acosta, Jose A. ; Kennedy, Susan ; Wang, Dennis S Y ; Sarveswaran, J. / Lumbar fractures in adult blunt trauma : Axial and single-slice helical abdominal and pelvic computed tomographic scans versus portable plain films. In: Journal of Trauma. 2002 ; Vol. 53, No. 4. pp. 663-667.
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abstract = "Background: Our hypothesis was that abdominal and pelvic computed tomographic (AP-CT) scans are equivalent to portable two-view plain films in detecting lumbar spine fractures in adults. Since many trauma patients often undergo AP-CT scanning to evaluate for possible intra-abdominal injuries, using the AP-CT scan to screen for lumbar fractures could make the trauma evaluation process more efficient. Methods: The institutional trauma registry at a Level I trauma center was used to identify all blunt lumbar fractures during a 6-year period. Medical records were reviewed. Results: A total of 7,216 adult blunt trauma patients were evaluated, and 115 patients were identified as having a lumbar fracture, for an incidence rate of 1.6{\%}. Missed fracture rates were high for both AP-CT scans (23.2{\%}, 13 of 56) and portable two-view films (12.7{\%}, 14 of 110, p = 0.08). Fifty-two patients had both AP-CT scans and plain films. In this group, AP-CT scans missed 23.1{\%} (12 of 52) of the lumbar fractures and plain films missed 15.4{\%} (8 of 52). However, the combination of the two diagnostic methods did not miss any fractures (0 of 52). The missed fractures required surgery or brace in 50{\%} (7 of 14) patients who had fractures missed by plain films and 46{\%} (6 of 13) patients whose fractures were missed by AP-CT scanning. Conclusion: Both AP-CT scans and plain films failed to diagnose significant lumbar fractures that required therapy. When screening for lumbar fractures, obtaining both AP-CT scans and portable two-view plain films may decrease missed lumbar fractures in blunt adult trauma.",
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