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Clearance of the asymptomatic cervical spine: a meta-analysis
Paul A Anderson1, Ryan D Muchow, Alejandro Munoz
1Department of Orthopedic Surgery and Rehabilitation, University of Wisconsin, Madison, WI 53792, USA. anderson@orthorehab.wisc.edu
Objectives:
To perform a comprehensive review of the literature and subsequent meta-analysis of data regarding appropriate clearance of the asymptomatic cervical spine in blunt trauma patients. The goal is to identify an asymptomatic patient group that can safely be cleared of cervical spine immobilization without radiographic evaluation.
Data Sources:
The National Library of Medicine was searched for English-language articles published between 1966 and December 2004. The key words spinal injury, spinal fracture, spinal injuries, cervical, clearance, diagnosis, and radiography were used to perform the search.
Study Selection:
Inclusion criteria were 1) a prospectively applied protocol; 2) reported outcomes to allow calculation of sensitivity, specificity, negative predictive value, and positive predictive value; and 3) follow up to determine the status of potential injuries with minimum of a 2-week telephone call or a computerized tomography scan. No exclusion criteria were applied.
Data Extraction:
The three senior authors independently confirmed the validity of the included papers for meeting appropriate criteria for the meta-analysis. True-positives, true-negatives, false-positives, and false-negatives were extracted from these studies.
Data Synthesis:
Original scale and log odds meta-analysis were performed using random effects methodology to calculate sensitivity, specificity, positive predictive value, and negative predictive value.
Conclusions:
An alert, asymptomatic patient without a distracting injury or neurologic deficit who is able to complete a functional range-of-motion examination may safely be cleared from cervical spine immobilization without radiographic evaluation (sensitivity = 98.1%, negative predictive value = 99.8%).