Interesting study found in Medscape that was presented at the ACEP conference this year. In this study, cervical spine CT scans detected 100% of clinically significant cervical spine injuries while 3 view cervical spine x-rays detected only 33% of clinically significant cervical spine injuries.
If these numbers are able to be replicated, should we continue performing cervical spine x-rays in trauma patients?
About 10,000 Americans have cervical spine injuries each year, and delayed diagnosis has important clinical and economical costs. CSRs have a reported sensitivity ranging from 35% to 89%; the study authors conducted a study to determine whether CCT has greater sensitivity in the detection of these injuries than CSR.
They carried out a prospective study of patients who presented with blunt trauma during the course of 23 months at an urban public hospital’s trauma center. Patients received both a 3-view CSR and CCT, each read independently by attending radiologists who were blinded to other tests.
Of 1580 study patients, 60 (4%) had injuries that were detected by CSR or CCT. CSR detected the injury in 21 of these patients (35% sensitivity), whereas CCT detected injuries in 58 patients (97% sensitivity). Of the 60 patients, 45 had injuries that were considered clinically significant (defined as requiring an operating room procedure, halo application, or hard collar). CCT identified all of these cases (100% sensitivity), whereas CSR detected just 15 injuries (33% sensitivity). In 2 cases, injury was identified by CSR and not CCT, but neither injury was clinically significant.
The study had some limitations, including the fact that it was conducted at a single institution and that 78 patients were dropped because of protocol violations. There was also no structured follow-up.