Substance abuse and diagnosis of cervical spine injuries: policy consideration

Cervical spine injury occurs in 2% to 6% of patients with blunt injury. Standard cervical radiographs are widely accepted as a primary screen, but may miss injuries. Diagnoses are further confounded by patients' use of alcohol or drugs, which may delay diagnosis.

To compare the rate of incomplete cervical radiographs and to compare the sensitivity of cervical radiographs and neck computed tomography (CT) in patients with cervical spine injury, with and without substance abuse.

A retrospective chart review.

A community teaching hospital.

Eighty-five high-severity trauma cases between 6/1/03 and 5/28/05.

Retrospective chart review of cervical spine imaging studies, alcohol levels, toxicology screens and clinical diagnosis.

Cervical radiographs generated false negatives or incomplete studies in all injured patients with significant levels of alcohol (> or = 80 mg/ dL) or drugs detected on toxicology screens. Cervical CT produced no false negatives.

Drug and alcohol screens are important adjunct studies to identify patients with substance abuse who are more prone to sustain cervical spine injury that is likely to be missed by plain cervical radiographs. Cervical CT maybe a better primary imaging study for detection of cervical spine injury in trauma patients with suspected substance abuse.