title: Magnetic resonance imaging in combination with helical computed tomography provides a safe and efficient method of cervical spine clearance in the obtunded trauma patient.
abstract: BACKGROUND
  Assessment of the cervical spine (c-spine) in the obtunded blunt trauma patient remains a diagnostic dilemma. In 2002, our institution implemented a new c-spine clearance guideline utilizing c-spine computed tomography (CT) and magnetic resonance imaging (MRI). This study evaluates the safety and efficacy of this guideline.
  
  
  METHODS
  Obtunded blunt trauma patients admitted over a 1-year period, who underwent both a c-spine CT and a c-spine MRI, were identified. Records were reviewed for demographics, mechanism, diagnostic evaluations, injuries, and outcome.
  
  
  RESULTS
  Fifty-two patients met inclusion criteria. On average, patients underwent a c-spine CT on postinjury day 0.4 and MRI on postinjury day 4. Forty-four patients had a negative c-spine CT, of whom 13 (30%) had a positive MRI for ligamentous injury (p < 0.01). Thirty-one patients had both a negative CT and a negative MRI. All patients (n = 8) with positive CTs had positive MRIs. The average Injury Severity Score, Abbreviated Injury Score head and neck, length of stay, and outcome was not significantly different for patients with a c-spine injury. No missed c-spine injuries and no areas of cervical collar-related skin breakdown were seen in follow up.
  
  
  CONCLUSIONS
  In the obtunded patient, expeditious c-spine evaluation is important. Both missed injuries and prolonged unnecessary immobilization can result in adverse outcomes. This study confirms that c-spine CT, when used in combination with MRI, provides a safe and efficient method for c-spine clearance in this patient population. CT alone misses a statistically significant number of c-spine injuries.
authors.affiliation: Department of Surgery, Division of Trauma and Emergency Surgery, University of Rochester School of Medicine, 601 Elmwood Avenue, Box SURG, Rochester, NY 14642, USA. nicole-stassen@urmc.rochester.edu
authors.forename: Nicole A
authors.initials: NA
authors.lastname: Stassen
authors.forename: Valerie A
authors.initials: VA
authors.lastname: Williams
authors.forename: Mark L
authors.initials: ML
authors.lastname: Gestring
authors.forename: Julius D
authors.initials: JD
authors.lastname: Cheng
authors.forename: Paul E
authors.initials: PE
authors.lastname: Bankey
mesh_terms: D000328:Adult; D002574:Cervical Vertebrae / Q000000981:diagnostic imaging / Q000293:injuries* / Q000473:pathology; D003072:Cognition Disorders / Q000209:etiology; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D019838:Neck Injuries / Q000000981:diagnostic imaging* / Q000473:pathology* / Q000523:psychology; D017410:Practice Guidelines as Topic; D012017:Referral and Consultation; D015203:Reproducibility of Results; D012189:Retrospective Studies; D036542:Tomography, Spiral Computed; D014949:Wounds, Nonpenetrating / Q000000981:diagnostic imaging* / Q000473:pathology* / Q000523:psychology