Computed tomographic scan: it's not just about the fracture.

Abstract

Computed tomography (CT) scan is the criterion standard to rule out cervical spine (c-spine) injury after blunt trauma. Many algorithms still include other tools to exclude ligamentous injuries that often lead to unnecessary prolonged collar use. The purpose of this study was to determine the accuracy of CT to rule out any clinically significant c-spine injury that would require intervention. We performed a retrospective review of a prospective study of blunt trauma patients between January 2008 and December 2012 at a Level 1 trauma center. For those patients identified with ligamentous injury, further chart review was performed to determine how it was diagnosed and treated. A total of 5,676 patients were identified. The median age was 39.0 years (18-103 years), median Glasgow Coma Scale (GCS) score was 15 (3-15), median Injury Severity Score (ISS) was 5 (1-75), median length of stay was 2 days (1-175 days), and mortality was 2.6%. The incidence of any injury to the c-spine was 7.4% (420 of 5,676). The incidence of fracture was 7.2% (409 of 5,676), while that of ligamentous injury was 0.92% (52 of 5,676). Of the 52 patients with ligamentous injury, 20 (38.4%) were suspected by CT. However, for those that were not suspected, all had associated fractures identified by CT, requiring further interventions. Hence, CT had a 100% sensitivity and specificity in ruling out c-spine injuries. CT scan of the c-spine is an excellent tool to rule out c-spine injury. For patients with a normal CT finding of the c-spine, no further imaging is necessary, and collars should be cleared as soon as possible. Prognostic study, level II; diagnostic study, level II.