Cervical spine clearance in obtunded blunt trauma patients: a prospective study.
BACKGROUND
: An acceptable algorithm for clearance of the cervical spine (C-spine) in the obtunded trauma patient remains controversial. Undetected C-spine injuries of an unstable nature can have devastating consequences. This has led to reluctance toward C-spine clearance in these patients.


OBJECTIVE
: To objectify the accuracy of computed tomography (CT) scanning compared with dynamic radiographs within a well established C-spine clearance protocol in obtunded trauma patients at a level I trauma center.


METHODS
: This was a prospective study of consecutive blunt trauma patients (18 years or older) admitted to a single institution between December 2004 and April 2008. To be eligible for study inclusion, patients must have undergone both a CT scan and dynamic plain radiographs of their C-spine as a part of their clearance process.


RESULTS
: Among 402 patients, there was one injury missed on CT but detected by dynamic radiographs. This resulted in a percentage of missed injury of 0.25%. Subsequent independent review of the CT scan revealed that in fact pathologic changes were present on the scan indicative of the injury.


CONCLUSIONS
: Our results indicate that CT of the C-spine is highly sensitive in detecting the vast majority (99.75%) of clinically significant C-spine injuries. We recommend that CT be used as the sole modality to radiographically clear the C-spine in obtunded trauma patients and do not support the use of flexion-extension radiographs as an ancillary diagnostic method.
Hennessy
Deirdre
D
Departments of Critical Care Medicine, Clinical Neurosciences, University of Calgary, Calgary, Alberta.
Widder
Sandy
S
Zygun
David
D
Hurlbert
R John
RJ
Burrowes
Paul
P
Kortbeek
John B
JB
D000328:Adult; D002574:Cervical Vertebrae / Q000293:injuries*; D003244:Consciousness Disorders / Q000150:complications*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011187:Posture; D011237:Predictive Value of Tests; D011446:Prospective Studies; D016059:Range of Motion, Articular; D015203:Reproducibility of Results; D013124:Spinal Injuries / Q000000981:diagnostic imaging* / Q000523:psychology* / Q000628:therapy; D014057:Tomography, X-Ray Computed; D014949:Wounds, Nonpenetrating / Q000000981:diagnostic imaging*; D055815:Young Adult