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Published on: November 8, 2024
Clinical identifiers for detecting underlying closed cervical fractures
Chad E Cook1, Phillip S Sizer, Robert E Isaacs
1Division of Physical Therapy, Walsh University, North Canton, Ohio, U.S.A.
Summary
Closed cervical fractures (CCFs) can be missed even after initial evaluation. Specific patient history and situational factors are key indicators for identifying these uncommon injuries, improving diagnostic accuracy.
Area of Science:
- Orthopedics
- Trauma Surgery
- Diagnostic Accuracy
Background:
- Closed cervical fractures (CCFs) are rare but can be overlooked in clinical settings.
- Initial workups may fail to detect CCFs, necessitating further investigation.
Purpose of the Study:
- To identify patient history and situational characteristics associated with missed closed cervical fractures.
- To improve the diagnostic accuracy for detecting CCFs.
Main Methods:
- Retrospective analysis of 162 patients with cervical pain undergoing surgical consultation.
- Calculation of diagnostic accuracy values (sensitivity, specificity, LR+/LR-) for targeted variables.
- Clustered analysis of patient history and situational factors.
Main Results:
- 11 patients (6.7%) were diagnosed with CCF.
- Six variables were significantly associated with missed CCFs.
- Absence of 2 variables strongly ruled out CCF (LR- = 0.0), while presence of 4 variables strongly suggested CCF (LR+ = 32).
Conclusions:
- Patient history and situational factors remain valuable for diagnosing CCFs post-initial examination.
- Clinicians need to maintain vigilance for CCFs, even during emergent care screenings.
- Improved identification of CCFs can prevent delayed diagnosis and treatment.
