title: Is magnetic resonance imaging in addition to a computed tomographic scan necessary to identify clinically significant cervical spine injuries in obtunded blunt trauma patients?
abstract: BACKGROUND
  Guidelines are in place directing the clearance of the cervical spine in patients who are awake, alert, and oriented, but a gold standard has not been recognized for patients who are obtunded. Our study is designed to determine if magnetic resonance imaging (MRI) detects clinically significant injuries not seen on computed tomographic (CT) scans.
  
  
  METHODS
  The trauma registry was used to identify and retrospectively review medical records of blunt trauma patients from January 1, 2005, to March 30, 2012. Only obtunded patients with a CT scan and MRI of the cervical spine were included.
  
  
  RESULTS
  The study cohort consisted of 277 patients. In 13 (5%) patients, MRI detected clinically significant cervical spine injuries that were missed by CT scans, and in 7 (3%) these injuries required intervention. The number needed to screen with MRI to prevent 1 missed injury was 21.
  
  
  CONCLUSIONS
  The findings suggest that the routine use of MRI in clearing the cervical spine in the obtunded blunt trauma patient.
authors.affiliation: Department of Surgery, Mailstop 8312, Texas Tech University Health Sciences Center, 3601 4th Street, Lubbock, TX 79430, USA.
authors.forename: Brian M
authors.initials: BM
authors.lastname: Fisher
authors.forename: Steven
authors.initials: S
authors.lastname: Cowles
authors.forename: Jennifer R
authors.initials: JR
authors.lastname: Matulich
authors.forename: Bradley G
authors.initials: BG
authors.lastname: Evanson
authors.forename: Diana
authors.initials: D
authors.lastname: Vega
authors.forename: Sharmila
authors.initials: S
authors.lastname: Dissanaike
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002574:Cervical Vertebrae / Q000000981:diagnostic imaging / Q000293:injuries* / Q000473:pathology; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D017410:Practice Guidelines as Topic; D015203:Reproducibility of Results; D012189:Retrospective Studies; D013124:Spinal Injuries / Q000175:diagnosis*; D014057:Tomography, X-Ray Computed / Q000379:methods*; D014193:Trauma Centers; D014949:Wounds, Nonpenetrating / Q000175:diagnosis*; D055815:Young Adult
keywords: Blunt trauma patient; Cervical spine computed tomography; Cervical spine injury; Cervical spine magnetic resonance imaging; Obtunded