title: Additional Imaging in Alert Trauma Patients with Cervical Spine Tenderness and a Negative Computed Tomographic Scan: Is it Needed?
abstract: BACKGROUND
  The value of additional imaging in clearing the cervical spine (C-spine) of alert trauma patients with tenderness on clinical exam and a negative computed tomographic (CT) scan is still unclear.
  
  
  METHODS
  All adult trauma patients with a Glasgow Coma Scale of 15, C-spine tenderness in the absence of neurologic signs, and a negative C-spine CT were included. The study period extended from September 2011 to June 2012. C-spine CT scans were interpreted in detail and considered negative in the absence of any findings indicating bony, ligamentous, or soft tissue injury around the C-spine. The incidence of C-spine injury was evaluated using early (<24 h) repeat physical examination, MRI, and/or flexion-extension films.
  
  
  RESULTS
  Of 2015 patients with a C-spine CT, 383 (19 %) fulfilled the inclusion criteria. The median age was 43 (IQR: 30-53) and 44.7 % were female. Thirty-six patients (9.4 %) underwent MRI (3.7 %), flexion-extension imaging (5.2 %), or both (0.5 %), with no significant injuries identified and subsequent removal of the collar allowed. The remaining patients were clinically cleared within 24 h of presentation. None of the patients developed neurological signs following removal of the collar. On bivariate analysis, no variable except for evaluation by trauma surgery was associated with performance of additional imaging.
  
  
  CONCLUSIONS
  C-spine precautions can be withdrawn without additional imaging in most blunt trauma patients with C-spine tenderness but negative neurologic evaluation and C-spine CT. Focus should be placed on the detailed and comprehensive interpretation of the C-spine CT.
authors.affiliation: Division of Trauma, Emergency Surgery, and Surgical Critical Care, Department of Surgery, Massachusetts General Hospital, Boston, MA, USA.
authors.forename: Michael N
authors.initials: MN
authors.lastname: Mavros
authors.affiliation: Division of Trauma, Emergency Surgery, and Surgical Critical Care, Department of Surgery, Massachusetts General Hospital, Boston, MA, USA.
authors.forename: Haytham M A
authors.initials: HM
authors.lastname: Kaafarani
authors.affiliation: Division of Trauma, Emergency Surgery, and Surgical Critical Care, Department of Surgery, Massachusetts General Hospital, Boston, MA, USA.
authors.forename: Ali Y
authors.initials: AY
authors.lastname: Mejaddam
authors.affiliation: Division of Trauma, Emergency Surgery, and Surgical Critical Care, Department of Surgery, Massachusetts General Hospital, Boston, MA, USA.
authors.forename: Elie P
authors.initials: EP
authors.lastname: Ramly
authors.affiliation: Division of Emergency Radiology, Department of Radiology, Massachusetts General Hospital, Boston, MA, USA.
authors.forename: Laura
authors.initials: L
authors.lastname: Avery
authors.affiliation: Division of Trauma, Emergency Surgery, and Surgical Critical Care, Department of Surgery, Massachusetts General Hospital, Boston, MA, USA.
authors.forename: Peter J
authors.initials: PJ
authors.lastname: Fagenholz
authors.affiliation: Division of Trauma, Emergency Surgery, and Surgical Critical Care, Department of Surgery, Massachusetts General Hospital, Boston, MA, USA.
authors.forename: D Dante
authors.initials: DD
authors.lastname: Yeh
authors.affiliation: Division of Trauma, Emergency Surgery, and Surgical Critical Care, Department of Surgery, Massachusetts General Hospital, Boston, MA, USA.
authors.forename: Marc A
authors.initials: MA
authors.lastname: de Moya
authors.affiliation: Division of Trauma, Emergency Surgery, and Surgical Critical Care, Department of Surgery, Massachusetts General Hospital, Boston, MA, USA. gvelmahos@partners.org.|Massachusetts General Hospital and Harvard Medical School, 165 Cambridge St Suite 810, Boston, MA, 02114, USA. gvelmahos@partners.org.
authors.forename: George C
authors.initials: GC
authors.lastname: Velmahos
mesh_terms: D000328:Adult; D002574:Cervical Vertebrae / Q000000981:diagnostic imaging* / Q000293:injuries; D005260:Female; D015600:Glasgow Coma Scale; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D008875:Middle Aged; D013124:Spinal Injuries / Q000000981:diagnostic imaging*; D014057:Tomography, X-Ray Computed / Q000379:methods*