title: Sticking our neck out: is magnetic resonance imaging needed to clear an obtunded patient's cervical spine?
abstract: BACKGROUND
  Evaluating the cervical spine in the obtunded trauma patient is a subject fraught with controversy. Some authors assert that a negative computed tomography (CT) scan is sufficient. Others argue that CT alone misses occult unstable injuries, and magnetic resonance imaging (MRI) will alter treatment. This study examines the data in an urban, county trauma center to determine if a negative cervical spine CT scan is sufficient to clear the obtunded trauma patient.
  
  
  METHODS
  Records of all consecutive patients admitted to a level 1 trauma center from January 2000 to December 2011 were retrospectively analyzed. Patients directly admitted to the intensive care unit with a Glasgow Coma Scale score ≤13, contemporaneous CT and MRI, and a negative CT reading were included. The results of the cervical spine MRI were analyzed.
  
  
  RESULTS
  A total of 309 patients had both CT and MRI, 107 (35%) of whom had negative CTs. Mean time between CT and MRI was 16 d. Of those patients, seven (7%) had positive acute traumatic findings on MRI. Findings included ligamentous injury, subluxation, and fracture. However, only two of these patients required surgical intervention. None had unstable injuries.
  
  
  CONCLUSIONS
  In the obtunded trauma patient with a negative cervical spine CT, obtaining an MRI does not appear to significantly alter management, and no unstable injuries were missed on CT scan. This should be taken into consideration given the current efforts at cost-containment in the health care system. It is one of the larger studies published to date.
authors.affiliation: Division of Trauma and Critical Care, DeWitt Daughtry Department of Surgery, Jackson Memorial Hospital/University of Miami - Miller School of Medicine, Miami, Florida.
authors.forename: Shevonne S
authors.initials: SS
authors.lastname: Satahoo
authors.affiliation: Division of Trauma and Critical Care, DeWitt Daughtry Department of Surgery, Jackson Memorial Hospital/University of Miami - Miller School of Medicine, Miami, Florida.
authors.forename: James S
authors.initials: JS
authors.lastname: Davis
authors.affiliation: Division of Trauma and Critical Care, DeWitt Daughtry Department of Surgery, Jackson Memorial Hospital/University of Miami - Miller School of Medicine, Miami, Florida.
authors.forename: George D
authors.initials: GD
authors.lastname: Garcia
authors.affiliation: Division of Trauma and Critical Care, DeWitt Daughtry Department of Surgery, Jackson Memorial Hospital/University of Miami - Miller School of Medicine, Miami, Florida.
authors.forename: Salman
authors.initials: S
authors.lastname: Alsafran
authors.affiliation: Division of Trauma and Critical Care, DeWitt Daughtry Department of Surgery, Jackson Memorial Hospital/University of Miami - Miller School of Medicine, Miami, Florida.
authors.forename: Reeni K
authors.initials: RK
authors.lastname: Pandya
authors.affiliation: Division of Trauma and Critical Care, DeWitt Daughtry Department of Surgery, Jackson Memorial Hospital/University of Miami - Miller School of Medicine, Miami, Florida.
authors.forename: Cheryl D
authors.initials: CD
authors.lastname: Richie
authors.affiliation: Division of Trauma and Critical Care, DeWitt Daughtry Department of Surgery, Jackson Memorial Hospital/University of Miami - Miller School of Medicine, Miami, Florida.
authors.forename: Fahim
authors.initials: F
authors.lastname: Habib
authors.affiliation: Department of Radiology, Jackson Memorial Hospital/University of Miami - Miller School of Medicine, Miami, Florida.
authors.forename: Luis
authors.initials: L
authors.lastname: Rivas
authors.affiliation: Division of Trauma and Critical Care, DeWitt Daughtry Department of Surgery, Jackson Memorial Hospital/University of Miami - Miller School of Medicine, Miami, Florida.
authors.forename: Nicholas
authors.initials: N
authors.lastname: Namias
authors.affiliation: Division of Trauma and Critical Care, DeWitt Daughtry Department of Surgery, Jackson Memorial Hospital/University of Miami - Miller School of Medicine, Miami, Florida. Electronic address: cschulman@med.miami.edu.
authors.forename: Carl I
authors.initials: CI
authors.lastname: Schulman
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002574:Cervical Vertebrae / Q000000981:diagnostic imaging / Q000473:pathology*; D003244:Consciousness Disorders / Q000000981:diagnostic imaging / Q000473:pathology*; D005260:Female; D006801:Humans; D007593:Joint Instability / Q000000981:diagnostic imaging / Q000473:pathology; D008022:Ligaments / Q000000981:diagnostic imaging / Q000293:injuries / Q000473:pathology; D008279:Magnetic Resonance Imaging / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D019838:Neck Injuries / Q000000981:diagnostic imaging / Q000473:pathology*; D012042:Registries; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed / Q000706:statistics & numerical data; D019564:Unnecessary Procedures; D055815:Young Adult
keywords: CT; Cervical spine; Imaging; MRI; Obtunded; Trauma