CT vs MRI C-Spine Imaging for C-Spine Clearance in Obtunded Patients in Low-Energy Trauma Mechanisms

BackgroundCurrent guidelines from trauma societies recommend cervical spine (c-spine) clearance for obtunded blunt trauma patients after negative CT c-spine (CS-CT). However, the value of additional c-spine MRI (CS-MRI) in patients with low-energy trauma mechanisms is unclear and controversial. This study hypothesizes that obtunded blunt low-energy mechanism trauma patients would not have c-spine injuries requiring surgery on CS-MRI after negative CS-CT.MethodsA retrospective review was conducted at a level 1 trauma center, analyzing adults with low-energy blunt trauma from 2018-2022. Inclusion criteria encompassed individuals over 18 years old admitted to the ICU following assault/fall 10 feet or less requiring intubation for 24+ hours. Exclusion criteria included patients with high-energy trauma or intubated later in their admission/less than 24 hours. Primary outcomes were c-spine injuries identified on MRI following negative CS-CT and percentage of patients requiring surgery. Statistical significance was set at 5%.ResultsOf 1462 charts, 300 patients met inclusion criteria. Of these 300 patients, 194 underwent only CS-CT (64.7%), while 106 underwent both CT and MRI (35.3%). Among the 82 patients with negative CS-CT who received CS-MRI, only 1 (1.2%) was found to have an unstable c-spine injury. Patients who underwent CS-MRI had increased ICU length of stay (7.52 vs 11.87 days) and ventilator days (6.12 vs 9.43 days) compared CS-CT alone.DiscussionThe findings suggest that negative CS-CT is typically sufficient for clearance in low-energy trauma patients. Additional CS-MRI may increase health care resource use without revealing significant injuries, supporting streamlined c-spine clearance protocols based on trauma mechanism.