Do flexion extension plain films facilitate treatment after trauma?

Area of Science:

• Orthopedics
• Radiology
• Trauma Surgery

Background:

• Cervical spine ligamentous injuries are a significant concern in blunt trauma patients.
• Flexion extension (FE) films are a traditional imaging modality used in diagnosis.
• The diagnostic utility and impact of FE films on patient management remain debated.

Purpose of the Study:

• To evaluate the diagnostic performance of flexion extension (FE) films compared to five-view plain films and CT scans for cervical spine ligamentous injuries.
• To assess the impact of FE films on clinical decision-making and patient outcomes.
• To determine the cost-effectiveness of FE films in the context of blunt trauma evaluation.

Main Methods:

• Retrospective review of 22,929 blunt trauma patients from January 2000 to December 2008.
• Analysis of 303 FE films in 271 patients, comparing their diagnostic accuracy with five-view plain films and CT scans.
• Evaluation of film completeness, ambiguity, and impact on management decisions.

Main Results:

• FE films demonstrated lower sensitivity and positive predictive value compared to five-view and CT scans for ligamentous injury diagnosis.
• A significant percentage of FE films were incomplete (20.5%) or ambiguous (9.2%), hindering reliable interpretation.
• No changes in management occurred for the two patients with missed ligament injuries on FE films.
• The cost of FE studies was substantial ($162,105.00 for 303 studies).

Conclusions:

• Flexion extension films are often incomplete and unreliable for diagnosing cervical spine ligamentous injuries in blunt trauma.
• FE films do not reliably facilitate treatment decisions and may increase healthcare costs and prolong the use of cervical collars.
• Alternative imaging modalities like five-view plain films and CT scans offer superior diagnostic accuracy and should be considered.