R. Kang1, C. Ingersol1, K. Herzing1, A. P. Ekeh1 1Wright State University,Surgery,Dayton, OH, USA
Introduction:
CT of the Cervical Spine(CT CS) is utilized widely in the evaluation of moderate to severely injured patients. In neurologically intact patients with imaging negative for injuries, but with persistent neck midline tenderness, a variety of protocols for further evaluation have been adopted by trauma centers including the use of Magnetic Resonance Imaging(MRI). The necessity and cost of this modality has been questioned in the presence of a negative high quality CT CS. We sought to ascertain changes in clinical management in this population of patients after a protocol change at a Level I Trauma Center.
Methods:
Data were retrospectively collected for patients seen at a Level 1 Trauma Center between Dec 2014- Jan 2015. Patients were identified through the trauma registry and cross-referenced with a database from the radiology department. All patients that obtained either a CS CT, MRI, or both CS CT and MRI during the specified period were identified. For our analysis, only patients that received both a CS CT and MRI with persistent neck pain and no neurological deficits were selected. The charts of these patients were reviewed for demographic and clinical data, including: age, gender, mechanism of injury, diagnosis on admission, length of hospital stay, length of ICU stay, injury severity score (ISS), results of the CS CT, and results of the MRI. This study followed a policy change on the trauma service in which patients with persistent tenderness were with negative CT CS were sent for MRI and the use of Flexion Extension films was discontinued.
Results:
In the two years studied, 485 patients were identified. 485 patients obtained a CS CT(n = 142), MRI(n = 46), or both a CS CT and MRI(n = 260) Of these patients that received both a CS CT and an MRI, the mean age was 50.7 years and males 64.2%. Motor Vehicle Crashes (MVCs) (41.5%), falls(37.3%), auto vs. and motorcycle crashes (5.4%) were the most common etiologies. Of the 260 patients who received both a CS CT and an MRI, 72(27.7%) had additional findings on MRI not seen on CT. In these patients with additional MRI findings, there was no intervention in 69.4% surgery in 26.3% and outpatient follow-up 4.2%. In all 72 of these cases, the findings on MRI did not change management. When comparing patients that had a difference between their CS CT and MRI and those that did not, there was significant difference between age, length of hospital stay, length of ICU stay, or ISS. There was also no significant difference between mechanism of injury or diagnosis on admission.
Conclusion:
The optimal management of neurologically intact patients with persistent neck pain following a negative CS CT remains controversial. In patients with a negative CS CT and persistent neck pain, MRI added little clinical value with no additional change in clinical management in any of the patients who had additional findings. A clear role for MRI in this population needs to be defined by well-designed prospective studies.