Application of imaging guidelines in patients with suspected cervical spine trauma: retrospective analysis and literature review.
Safe and efficient clearance of cervical spine injury in blunt trauma patients has been a controversial topic among health professionals. The increased availability of CT scanners in major trauma centers seems to be a factor that has led to increased number of unnecessary cervical spine imaging using this imaging modality. The objective of this study was to investigate the applicability and efficacy of a pre-test clinical criterion in order to stratify post-blunt trauma victims based on their risk of sustaining cervical spine injury and in turn recommend an appropriate imaging modality accordingly. Goergen's criteria (Australas Radiol 48(3):287, 2004), a pre-investigation diagnostic algorithm was retrospectively applied to 106 blunt trauma victims who presented to a level 1 trauma center in Sydney, Australia, and had a CT scan of cervical spine as part of their initial management. Overall, nine (8.5%) of patients sustained a significant cervical spine injury. All nine patients would be classified as high-risk victims according to the algorithm investigated in this study, warranting CT scanning. No patients with low-risk injuries were demonstrated to have a significant cervical spine injury. There was a statistically significant greater proportion of acute cervical spine injuries detected in the high-risk group (p value = 0.0024). Hence, using Goergen's diagnostic algorithm could reduce the number of unnecessary cervical spine CT scans ordered, while not compromising the quality of care in post-blunt trauma victims.
Kokabi
Nima
N
Northern Clinical School, Royal North Shore Hospital, University of Sydney, Reserve Road, St Leonards, NSW 2065, Australia. nkok4872@uni.sydney.edu.au
Raper
Daniel M S
DM
Xing
Minzhi
M
Giuffre
Bruno Mario
BM
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002574:Cervical Vertebrae / Q000000981:diagnostic imaging*; D005260:Female; D017408:Guidelines as Topic; D006801:Humans; D015601:Injury Severity Score; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013124:Spinal Injuries / Q000000981:diagnostic imaging*; D014057:Tomography, X-Ray Computed
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