Variation in the use of MRI for cervical spine clearance: an opportunity to simultaneously improve clinical care and...

Area of Science:

• Trauma Surgery
• Emergency Medicine
• Radiology

Background:

• Controversy exists regarding optimal cervical spine clearance in obtunded blunt trauma patients.
• Recent guidelines suggest MRI is not essential for collar clearance in this population.
• This study investigates national variations in MRI utilization and associated factors.

Purpose of the Study:

• To determine the extent of national variation in MRI use for cervical spine clearance.
• To identify patient-specific and hospital-specific factors influencing MRI practice.

Main Methods:

• Retrospective review of the National Trauma Data Bank (2007-2012).
• Inclusion of obtunded blunt trauma patients (GCS <8, AIS head >3, ventilated >72h) at Level 1 or 2 trauma centers.
• Multilevel modeling to analyze patient and hospital-level factors associated with spine MRI use.

Main Results:

• 32,125 patients from 395 trauma centers analyzed; mean MRI use was 9.9% (range 0.5%-68.7%).
• Younger patients and those with MVC/pedestrian injuries were more likely to receive MRI.
• Hospitals in the Northeast, Level 1 TCs, and non-teaching hospitals showed higher MRI utilization; ISS was not associated with MRI use.

Conclusions:

• Significant variation in MRI use persists, influenced by hospital characteristics (geography, level, teaching status) despite patient factors.
• Current national guidelines for limiting MRI in cervical spine evaluation are not consistently applied.
• Potential reasons include lack of physician awareness, institutional protocols, or clinical consensus.