title: Does the ratio and thickness of prevertebral soft tissue provide benefit in blunt cervical spine injury?
abstract: OBJECTIVE
  Although many reports advocate computed tomography (CT) as the initial surveillance tool for occult cervical spine injury (CSI) at the emergency department (ED), the role of a lateral cervical spine radiograph (LCSX) has still not been replaced. We hypothesized that the increased width of the prevertebral soft tissue on an LCSX provides helpful information for selecting the high-risk patients who need to be evaluated with more accurate diagnostic tools.
  
  
  METHODS
  This was a retrospective and consecutive series of injured patients requiring cervical spine evaluation who were first imaged with three-view plain films at the ED. The prevertebral soft tissue thickness (PVST) and ratio of prevertebral soft tissue thickness to the cervical vertebrae diameter (PVST ratio) were calculated on the LCSX. Suspicion of CSI was confirmed by either CT or magnetic resonance imaging (MRI) scans.
  
  
  RESULTS
  A total of 826 adult trauma patients requiring cervical spine evaluation were enrolled. The C3 PVST and PVST ratio were significantly different between patients with or without upper cervical area injury (UCAI, 8.64 vs. 5.49 mm, and 0.394 vs. 0.276, respectively), and, likewise, the C6 PVST and PVST ratio for patients with or without lower cervical area injury (LCAI, 16.89 vs. 14.66 mm, and 0.784 vs. 0.749, respectively). The specificity was greater than 90 % in predicting UCAI and LCAI when combining these two parameters.
  
  
  CONCLUSIONS
  This method maximizes the usefulness of LCSX during the initial assessment of a conscious patient with blunt head and neck injury, especially for the identification of high-risk patients requiring prompt CT or MRI; on the other hand, it prevents the overuse of these high-cost imaging studies as initial diagnostic tools.
authors.affiliation: Department of General Surgery, Tzu-Chi General Hospital and Tzu-Chi University, No.289, Jianguo Rd., Xindian Dist, New Taipei City , 23142, Taiwan, ROC. gp5066@gmail.com.|Department of General Surgery, Chang Gung Memorial Hospital and Chang Gung University, No. 5, Fuxing St., Guishan Township, Taoyuan County, 333, Taiwan, ROC. gp5066@gmail.com.
authors.forename: J-P
authors.initials: JP
authors.lastname: Shiau
authors.affiliation: Department of Pathology, Chang Gung Memorial Hospital and Chang Gung University, No. 5, Fuxing St., Guishan Township, Taoyuan County, 333, Taiwan, ROC. chinchihching@gmail.com.
authors.forename: C-C
authors.initials: CC
authors.lastname: Chin
authors.affiliation: Department of General Surgery, Chang Gung Memorial Hospital and Chang Gung University, No. 5, Fuxing St., Guishan Township, Taoyuan County, 333, Taiwan, ROC. ycn@gmail.com.
authors.forename: C-N
authors.initials: CN
authors.lastname: Yeh
authors.affiliation: Department of Neurosurgery, Chang Gung Memorial Hospital and Chang Gung University, No. 5, Fuxing St., Guishan Township, Taoyuan County, 333, Taiwan, ROC. chenjf@adm.cgmh.org.tw.
authors.forename: J-F
authors.initials: JF
authors.lastname: Chen
authors.affiliation: Department of Neurosurgery, Chang Gung Memorial Hospital and Chang Gung University, No. 5, Fuxing St., Guishan Township, Taoyuan County, 333, Taiwan, ROC. yun0710@adm.cgmh.org.tw.
authors.forename: S-T
authors.initials: ST
authors.lastname: Lee
authors.affiliation: Division of Trauma, Department of General Surgery, Chang Gung Memorial Hospital and Chang Gung University, No. 5, Fuxing St., Guishan Township, Taoyuan County, 333, Taiwan, ROC. jimjffang@hotmail.com.
authors.forename: J-F
authors.initials: JF
authors.lastname: Fang
authors.affiliation: Department of General Surgery, Chang Gung Memorial Hospital and Chang Gung University, No. 5, Fuxing St., Guishan Township, Taoyuan County, 333, Taiwan, ROC. liao2901.tw@gmail.com.|Department of Neurosurgery, Chang Gung Memorial Hospital and Chang Gung University, No. 5, Fuxing St., Guishan Township, Taoyuan County, 333, Taiwan, ROC. liao2901.tw@gmail.com.
authors.forename: C-C
authors.initials: CC
authors.lastname: Liao
keywords: Cervical spine injury; Cervical vertebrae; Lateral cervical spine radiograph; Prevertebral soft tissue; Prevertebral soft tissue thickness ratio
references.citation: AJR Am J Roentgenol. 1998 Oct;171(4):951-7
references.pmid: 9762974
references.citation: J Trauma. 2008 Jan;64(1):179-89
references.pmid: 18188119
references.citation: Am J Emerg Med. 1998 Jul;16(4):346-9
references.pmid: 9672447
references.citation: J Trauma. 1998 Jun;44(6):941-56; discussion 956-7
references.pmid: 9637148
references.citation: Eur J Radiol. 2004 Jul;51(1):73-6
references.pmid: 15186888
references.citation: J Trauma. 1993 Mar;34(3):342-6
references.pmid: 8483172
references.citation: J Trauma. 2003 Aug;55(2):222-6; discussion 226-7
references.pmid: 12913629
references.citation: Ann Emerg Med. 1994 Dec;24(6):1119-24
references.pmid: 7978594
references.citation: Skeletal Radiol. 1987;16(2):98-104
references.pmid: 3675731