Substance abuse and diagnosis of cervical spine injuries: policy consideration.
BACKGROUND
Cervical spine injury occurs in 2% to 6% of patients with blunt injury. Standard cervical radiographs are widely accepted as a primary screen, but may miss injuries. Diagnoses are further confounded by patients' use of alcohol or drugs, which may delay diagnosis.


OBJECTIVE
To compare the rate of incomplete cervical radiographs and to compare the sensitivity of cervical radiographs and neck computed tomography (CT) in patients with cervical spine injury, with and without substance abuse.


METHODS
A retrospective chart review.


METHODS
A community teaching hospital.


METHODS
Eighty-five high-severity trauma cases between 6/1/03 and 5/28/05.


METHODS
Retrospective chart review of cervical spine imaging studies, alcohol levels, toxicology screens and clinical diagnosis.


RESULTS
Cervical radiographs generated false negatives or incomplete studies in all injured patients with significant levels of alcohol (> or = 80 mg/ dL) or drugs detected on toxicology screens. Cervical CT produced no false negatives.


CONCLUSIONS
Drug and alcohol screens are important adjunct studies to identify patients with substance abuse who are more prone to sustain cervical spine injury that is likely to be missed by plain cervical radiographs. Cervical CT maybe a better primary imaging study for detection of cervical spine injury in trauma patients with suspected substance abuse.
Brohez
Murielle
M
Stamford Hospital, USA.
Brady
Paula C
PC
Rennie
Carla P
CP
Slabach
Rachel
R
Perez
Jose
J
Hall
Timothy S
TS
D000328:Adult; D002574:Cervical Vertebrae / Q000000981:diagnostic imaging / Q000293:injuries* / Q000473:pathology*; D005188:False Negative Reactions; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D012189:Retrospective Studies; D013124:Spinal Injuries / Q000000981:diagnostic imaging / Q000453:epidemiology* / Q000473:pathology*; D019966:Substance-Related Disorders / Q000453:epidemiology*; D014057:Tomography, X-Ray Computed