Accuracy of standard radiographic views in detecting cervical spine fractures.
Recent studies have challenged the accuracy of standard radiographs for detecting cervical spine injuries. We used thin-section tomography to determine the accuracy of the cross-table lateral view (CTLV) alone, and the three standard emergency department views (CTLV, anteroposterior, and open-mouth) together, for detecting acute cervical spine fractures. Seventy-one patients with blunt cervical spine injuries had thin-section tomography performed for the following indications: fracture, dislocation, or suspicious findings on standard radiographs; or persistent severe pain or neurologic deficit. Tomography detected acute fractures in 44 of the 71 patients. The CTLV had a sensitivity of 82%, specificity of 70%, and accuracy of 77% for detecting patients with fractures. The three standard views had a corresponding sensitivity, specificity, and accuracy of 93%, 71%, and 84%, respectively. Eight patients with fractures had the CTLV interpreted as normal, and three patients with fractures had all three standard views interpreted as normal. The use of thin-section tomography is recommended when there are suspicious radiographic or clinical findings suggesting a severe cervical spine injury.
D002574:Cervical Vertebrae / Q000000981:diagnostic imaging; D004630:Emergencies; D005069:Evaluation Studies as Topic; D005260:Female; D050723:Fractures, Bone / Q000000981:diagnostic imaging*; D006801:Humans; D008297:Male; D013124:Spinal Injuries / Q000000981:diagnostic imaging*; D014057:Tomography, X-Ray Computed / Q000379:methods*