CT scans proved essential for detection of significant cervical spine injuries

CT can be used to detect these injuries in patients after blunt trauma and were so effective an MRI may not be necessary, according to investigators.

Researchers found in a recent study that for patients who have a cervical spine injury due to blunt trauma, and cannot be cleared by NEXUS low risk criteria from a cervical spine injury, MRI scans are typically unnecessary and can be eliminated if a CT scan is negative.

“For patients who suffer blunt trauma and cannot be cleared by NEXUS criteria from a cervical spine injury, because of either cervical spine tenderness or a sensory deficit, a CT is sufficient for ruling out a clinically significant injury,” Shelby Resnick, MD, told Spine Surgery Today. “In our study, MRI did not change the management of our patients and can therefore be safely eliminated from the diagnostic algorithm, potentially saving hospitals and patients’ time and money,” she said.

The study was published in JAMA Surgery.

Resnick and colleagues conducted a prospective observational study at a level 1 trauma center from Jan. 1 to May 31, 2011 in which they studied 830 adults who were awake, alert and able to be examined after blunt trauma with resultant cervical spine midline tenderness who also underwent a CT of the cervical spine.

No differences in imaging

They identified 164 cervical spine injuries that were diagnosed, of which 23 were clinically significant. All of the clinically significant injuries were identified by the CT, according to the study abstract. Fifteen of 681 patients (2.2%) with a CT scan had newly identified findings revealed by an MRI, but none of those injuries required surgery or halo placement. The management of the patients with new findings on MRI was unchanged, Resnick and colleagues noted.

In the study, Resnick and colleagues reported that CT scans found 100% of clinically significant cervical spine injuries and had 100% sensitivity and 100% specificity. For all types of cervical spine injuries, CT scans had 90.9% sensitivity and 100% specificity, based on study results.

Patients not within the NEXUS (National Emergency X-Radiography Utilization Study) low risk criteria can be categorized into two subgroups; those who are awake, alert, able to be examined and have either residual tenderness or a neurological deficit, and patients who are not able to be evaluated at all, Resnick and colleagues noted.

Reduces stays, costs

Eliminating the need for an MRI for patients with cervical spine injuries from blunt trauma can reduce costs and the average length of hospital stay, Resnick and colleagues noted. In their trauma center, MRIs are typically not performed on the weekend or holidays and the average wait between a CT scan and MRI is about 2.1 days, a process that could be streamlined by eliminating the MRI, according to the researchers, and this would help to decrease a patient’s discomfort and average length of stay.

According to Resnick, the investigators are conducting their next study in this area of research.

“The next step will be to perform this same study on the population of patients who are not amenable to examination because of a decreased GCS [Glasgow Coma Scale score]. We are currently well into a prospective, observational multicenter study, as part of the Western Trauma Association multicenter trials group, designed to validate our study findings and also look at the unevaluable patients,” she said. – by Robert Linnehan

Reference:

Resnick S. JAMA Surg. 2014;doi:10.1001/jamasurg.2014.867.

For more information:

Shelby Resnick, MD, can be reached at the Division of Acute Care Surgery, Department of Surgery at the USC Medical Center, 1200 N. State St, Inpatient Tower (C), Room C5L100, Los Angeles, CA 90033; email: shelby.resnick@med.usc.edu.

Disclosure: Resnick has no relevant financial disclosures.