title: Outcomes at 12 months after early magnetic resonance imaging in acute trauma patients with persistent midline cervical tenderness and negative computed tomography.
abstract: METHODS
  A prospective observational cohort study of alert, neurologically intact trauma patients presenting to the emergency department with midline cervical tenderness. Screening cervical magnetic resonance imaging (MRI) had been conducted after negative computed tomography (CT) when tenderness was persistent.
  
  
  OBJECTIVE
  To determine the association of acute findings and demographic characteristics with any long-term neck disability, and with time to return to work in such patients.
  
  
  BACKGROUND
  The relationship between acute findings and outcomes in these patients is unknown, and we hypothesized that outcomes at 12 months would correlate with acute clinical signs and symptoms, MRI findings, and mechanisms of injury.
  
  
  METHODS
  Patients at a Level 1 trauma center with persistent midline cervical tenderness in the absence of evidence of intoxication, painful distracting injury, persistently abnormal neurology, or acute CT findings, who underwent early cervical MRI under the institutional protocol, were reviewed in the outpatient spine clinic after discharge. In addition, the factors associated with neck disability and time to return to work were examined at follow-up at 12 months after presentation.
  
  
  RESULTS
  There were 162 of 178 patients available for follow-up at 12 months (91%). Of these, 46% had MRI-identified cervical spine injury at their initial examination, and 22% had required clinical management, including 2.5% with operative stabilization. Neck disability was present in 43% of patients and was associated with depressive symptoms, workers' compensation, and low annual income. Delay in return to work was associated with the presence of minor limb/other fractures and depressive symptoms, whereas patients on high annual incomes were found to return to work more quickly.
  
  
  CONCLUSIONS
  Surprisingly in these acute trauma patients, MRI-detected injury, clinical factors, and injury mechanism were not found to be associated with long-term patient outcomes. As a result, a trial of a more targeted, individual return to work plan, including strategies aimed at improving physical and psychological function, may now be justified to optimize long-term recovery, reduce health resource costs, and maximize economic productivity through early return to work.
authors.affiliation: National Trauma Research Institute, The Alfred Hospital, Melbourne, Australia. h.ackland@alfred.org.au
authors.forename: Helen M
authors.initials: HM
authors.lastname: Ackland
authors.forename: Peter A
authors.initials: PA
authors.lastname: Cameron
authors.forename: Rory
authors.initials: R
authors.lastname: Wolfe
authors.forename: Gregory M
authors.initials: GM
authors.lastname: Malham
authors.forename: Dinesh K
authors.initials: DK
authors.lastname: Varma
authors.forename: Gregory J
authors.initials: GJ
authors.lastname: Fitt
authors.forename: D James
authors.initials: DJ
authors.lastname: Cooper
authors.forename: Jeffrey V
authors.initials: JV
authors.lastname: Rosenfeld
authors.forename: Susan M
authors.initials: SM
authors.lastname: Liew
mesh_terms: D000328:Adult; D002574:Cervical Vertebrae / Q000000981:diagnostic imaging* / Q000293:injuries*; D004185:Disability Evaluation; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D019838:Neck Injuries / Q000175:diagnosis / Q000000981:diagnostic imaging; D017063:Outcome Assessment, Health Care / Q000706:statistics & numerical data; D010146:Pain / Q000175:diagnosis; D016016:Proportional Hazards Models; D011446:Prospective Studies; D062707:Return to Work / Q000706:statistics & numerical data; D013124:Spinal Injuries / Q000175:diagnosis*; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D014193:Trauma Centers / Q000706:statistics & numerical data; D055815:Young Adult