Helical computed tomographic scanning for the evaluation of the cervical spine in the unconscious, intubated trauma patient.
BACKGROUND
Assessment of the spine in the unconscious trauma patient is limited by an inadequate clinical examination. The potential of a missed unstable disc or ligamentous injury results in many patients remaining immobilized in critical care units for prolonged periods.


METHODS
This study evaluates helical computed tomographic (CT) scanning of the whole cervical spine as part of a spinal assessment and clearance protocol.


RESULTS
Four hundred thirty-seven unconscious, intubated, blunt trauma patients underwent CT scanning of the cervical spine. Sixty-one patients had a cervical spine injury and 31 (7.0%) were unstable. CT scanning had a sensitivity of 98.1%, a specificity of 98.8%, and a negative predictive value of 99.7%. There were no missed unstable injuries. In contrast, an adequate lateral cervical spine film detected only 24 injuries (14 unstable), with a sensitivity of 53.3%.


CONCLUSIONS
Helical CT scanning of the cervical spine allows rapid and safe evaluation of the cervical spine in the unconscious, intubated trauma patient.
Brohi
Karim
K
Department of Trauma Surgery, Royal London Hospital, London, United Kingdom. karim@trauma.org
Healy
Marie
M
Fotheringham
Tim
T
Chan
Otto
O
Aylwin
Chris
C
Whitley
Siobhan
S
Walsh
Michael
M
D000328:Adult; D002574:Cervical Vertebrae / Q000000981:diagnostic imaging* / Q000293:injuries* / Q000473:pathology; D002985:Clinical Protocols; D005260:Female; D006801:Humans; D007442:Intubation, Intratracheal; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012680:Sensitivity and Specificity; D013124:Spinal Injuries / Q000150:complications* / Q000000981:diagnostic imaging* / Q000473:pathology; D016019:Survival Analysis; D036542:Tomography, Spiral Computed / Q000706:statistics & numerical data*; D014474:Unconsciousness / Q000150:complications* / Q000628:therapy*