Cervical spine assessment in the unconscious trauma patient: a major trauma service's experience with passive flexion-extension radiography.
BACKGROUND
There is no consensus on the most appropriate method of cervical spine assessment in unconscious trauma patients. Passive flexion-extension imaging is one option for further investigating unconscious patients whose plain cervical radiographs are normal. This study examines the usefulness of this passive imaging in investigating for occult cervical injury.


METHODS
All unconscious patients admitted to The Alfred Trauma Intensive Care Unit over 1 year (January 1-December 31, 1998), who could not be clinically assessed within 48 hours in regard to their cervical spine, were identified. Results of passive flexion-extension radiography were compared with final injury status and clinical outcome as determined by retrospective review of the imaging reports, radiographic films, and case notes.


RESULTS
One hundred twenty-three patients with normal three-view plain radiographs proceeded to passive functional investigation. These were false-negative in four of the seven patients with cervical spine injuries at presentation. No patients suffered any adverse neurologic events from their delayed diagnoses or from the flexion-extension procedure.


CONCLUSIONS
Passive flexion-extension imaging has inadequate sensitivity for detecting occult cervical spine injuries. Although no patients suffered adverse neurologic complications, the potential for devastating consequences from missed cervical injury has resulted in the removal of passive flexion-extension imaging from the screening protocol.
Department of Trauma Surgery, The Alfred Hospital, Monash University, Melbourne, Victoria 3004, Australia.
Ilan
I
Freedman
David
D
van Gelderen
D James
DJ
Cooper
Mark
M
Fitzgerald
Gregory
G
Malham
Jeffrey V
JV
Rosenfeld
Dinesh
D
Varma
Thomas
T
Kossmann
D000328:Adult; D002574:Cervical Vertebrae / Q000000981:diagnostic imaging*; D002985:Clinical Protocols; D005260:Female; D006801:Humans; D007362:Intensive Care Units / Q000592:standards*; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D011859:Radiography; D012680:Sensitivity and Specificity; D013124:Spinal Injuries / Q000000981:diagnostic imaging; D014193:Trauma Centers / Q000592:standards; D014474:Unconsciousness; D014739:Victoria