Rethinking cervical spine clearance in obtunded trauma patients: An updated systematic review and meta-analysis

Area of Science:

• Trauma Imaging
• Diagnostic Accuracy
• Spinal Injury Assessment

Background:

• Diagnosing cervical spine injuries (CSI) in obtunded adult blunt trauma patients presents diagnostic challenges.
• The optimal imaging modality for c-spine clearance in this population remains uncertain.
• This study systematically reviews evidence from the past decade regarding imaging requirements for CSI diagnosis.

Approach:

• A systematic review and meta-analysis adhering to PRISMA 2020 guidelines was performed.
• Searched MEDLINE, EMBASE, and Cochrane Library for studies comparing CT alone versus CT with MRI for c-spine clearance (2012-2023).
• Meta-analysis used a random-effect model; risk of bias and quality were assessed using ROBINS-I, QUADAS-2, and GRADE methodologies.

Key Points:

• Seven hundred forty-four obtunded trauma patients from six studies were analyzed.
• CT scans alone missed 6% of clinically significant CSI and 7% of CSI requiring treatment.
• High heterogeneity (I² > 84%) and low evidence quality were noted due to study design and variability.

Conclusions:

• Current evidence suggests CT scans alone may be insufficient for detecting clinically significant CSI in obtunded adult blunt trauma patients.
• Clinicians should consider MRI in conjunction with CT for comprehensive c-spine clearance.
• Future research should prioritize prospective studies with standardized outcomes and reporting.