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Computed tomographic scan: it's not just about the fracture
Poornima Vanguri1, Andrew J Young, William F Weber
1From the Virginia Commonwealth University (P.V., A.J.Y., J.K., J.H, L.G.W., T.M.D.) Richmond, Virginia; and AB Chandler Medical Center (W.F.W.), Lexington, Kentucky.
Computed tomography (CT) scans effectively rule out cervical spine (c-spine) injuries in trauma patients. A normal CT scan indicates no further imaging is needed, allowing for prompt collar removal.
Area of Science:
- Emergency medicine
- Radiology
- Trauma surgery
Background:
- Cervical spine (c-spine) injuries are a concern in blunt trauma.
- Computed tomography (CT) is the standard for diagnosing c-spine injuries.
- Current algorithms may include additional tests for ligamentous injuries, potentially causing prolonged immobilization.
Purpose of the Study:
- To evaluate the accuracy of CT scans in ruling out clinically significant c-spine injuries requiring intervention.
Main Methods:
- Retrospective review of a prospective study.
- Inclusion of blunt trauma patients from January 2008 to December 2012 at a Level 1 trauma center.
- Detailed chart review for patients with ligamentous injuries to determine diagnosis and treatment.
Main Results:
- A total of 5,676 patients were analyzed.
- The incidence of any c-spine injury was 7.4%, with 0.92% being ligamentous injuries.
- CT demonstrated 100% sensitivity and specificity for ruling out c-spine injuries, as all missed ligamentous injuries had associated fractures detected by CT.
Conclusions:
- CT scans of the cervical spine are highly accurate in excluding injuries.
- Normal CT findings eliminate the need for further imaging.
- Collars can be removed promptly in patients with normal CT results.
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