J. S. Hanna2, V. Sim2, C. King1, A. Rayner3, R. Gupta2 1Rutgers Robert Wood Johnson Medical School,Department Of Radiology,New Brunswick, NJ, USA 2Rutgers Robert Wood Johnson Medical School,Division Of Acute Care Surgery,New Brunswick, NJ, USA 3Rutgers Robert Wood Johnson Medical School,Department Of Surgery,New Brusnwick, NJ, USA
Introduction:
Missed cervical spine injuries may result in devastating morbidity and mortality. Debate continues over the optimal method for identifying clinically relevant cervical spine injuries. The adequacy of computed tomography (CT) alone and the role of magnetic resonance imaging (MRI) in assessing ligamentous injury remains controversial. We hypothesize that CT scan alone is neither 100% sensitive nor specific because of equipment and provider heterogeneity.
Methods:
A prospectively maintained database at a level one trauma center was queried for all trauma patients with a negative cervical spine CT scan who required an MRI for persistent midline cervical tenderness (MCT) or altered mental status (AMS) between 2011 and 2016. 838 patients were identified for which a retrospective chart review was performed to identify admission characteristics, imaging findings, and clinical management.
Results:
The identified cohort was composed of 649 patients with persistent MCT and 189 patients with AMS. MRI identified clinically relevant injuries not seen on CT in 5% of patients with MCT and AMS each. In the MCT group 4% were managed with a cervical collar and 1% required surgery. In the AMS group 4.8% were managed with a cervical collar and 0.2% with surgery. In the absence of a cervical spine fracture, the sensitivity and specificity of CT alone in detecting ligamentous injury in this cohort is 2.3% and 100% respectively.
Conclusion:
These data suggest that a negative CT alone is insufficient to exclude injuries resulting in cervical spine instability. Although recent studies have suggested CT scan is 100% sensitive and specific, we believe that equipment and interpreter heterogeneity substantially decrease the sensitivity. We recommend that each institution perform an internal validation prior to developing protocols which rely solely on CT imaging to exclude clinically relevant cervical spine injuries.