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Are cervical spine radiograph examinations useful in patients with low clinical suspicion of cervical spine fracture? An experience with 254 cases

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Abstract

Trauma patients with low clinical suspicion of cervical spine fracture are often examined with a plain X-ray cervical spine series rather than with cervical spine computed tomography (CT). The authors have been concerned by the absence of fractures in the group of patients examined with plain X-ray. The objective of this investigation was to determine the usefulness of plain X-ray examinations in suspected cases of cervical spine fracture compared to CT. A retrospective review was performed of all trauma patients undergoing imaging for suspected cervical spine fracture in our Emergency Department over a one-year period (January 1, 2007 to December 31, 2007). During the study period, 254 cervical spine plain X-ray and 3,080 cervical spine CT examinations were performed. Of the 254 plain X-ray examinations, 237 were interpreted as negative for fracture, 11 were suboptimal examinations, and six were interpreted as possible fractures (later ruled out by further imaging). Of the 3,080 CT examinations, 2,884 were interpreted as negative for fracture and 196 as positive. The overall positivity rates for acute cervical spine fracture were 0.0% in plain X-ray and 6.4% in CT examinations. These data confirm the authors’ concern that plain X-ray imaging for patients with low clinical suspicion for cervical spine trauma in our hospital may have too low a yield to justify its use. However, the 6.4% positivity rate in the group of patients selected for CT examination justifies its use in this group.

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References

  1. Daffner RH, Hackney DB (2007) ACR Appropriateness Criteria on suspected spine trauma. J Am Coll Radiol 4(11):762–775. doi:10.1016/j.jacr.2007.08.006

    Article  PubMed  Google Scholar 

  2. Nuñez DB, Ahmad AA, Coin CG, LeBlang S, Becerra JL, Henry R, Lentz K, Quencer RM (1994) Clearing the cervical spine in multiple trauma victims: a time-effective protocol using helical computed tomography. Emerg Radiol 1(6):273–278. doi:10.1007/BF02614949

    Article  Google Scholar 

  3. Blackmore CC, Ramsey SD, Mann FA, Deyo RA (1999) Cervical spine screening with CT in trauma patients: a cost-effectiveness analysis. Radiology 212(1):117–125

    CAS  PubMed  Google Scholar 

  4. Daffner RH (2000) Cervical radiography for trauma patients: a time-effective technique? AJR Am J Roentgenol 175(5):1309–1311

    CAS  PubMed  Google Scholar 

  5. Holmes JF, Akkinepalli R (2005) Computed tomography versus plain radiography to screen for cervical spine injury: a meta-analysis. J Trauma 58(5):902–905. doi:10.1097/01.TA.0000162138.36519.2A

    Article  PubMed  Google Scholar 

  6. Stiell IG, Wells GA, Vandemheen KL, Clement CM, Lesiuk H, De Maio VJ, Laupacis A, Schull M, McKnight RD, Verbeek R, Brison R, Cass D, Dreyer J, Eisenhauer MA, Greenberg GH, MacPhail I, Morrison L, Reardon M, Worthington J (2001) The Canadian C-spine rule for radiography in alert and stable trauma patients. JAMA 286(15):1841–1848. doi:10.1001/jama.286.15.1841

    Article  CAS  PubMed  Google Scholar 

  7. Hoffman JR, Mower WR, Wolfson AB, Todd KH, Zucker MI (2000) Validity of a set of clinical criteria to rule out injury to the cervical spine in patients with blunt trauma. National Emergency X-Radiography Utilization Study Group. N Engl J Med 343(2):94–99. doi:10.1056/NEJM200007133430203

    Article  CAS  PubMed  Google Scholar 

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Correspondence to Benjamin B. Lange or Robert A. Novelline.

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Lange, B.B., Penkar, P., Binder, W.D. et al. Are cervical spine radiograph examinations useful in patients with low clinical suspicion of cervical spine fracture? An experience with 254 cases. Emerg Radiol 17, 191–193 (2010). https://doi.org/10.1007/s10140-009-0830-x

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  • DOI: https://doi.org/10.1007/s10140-009-0830-x

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