TY - JOUR
T1 - Adequacy and efficacy of lateral cervical spine radiography in alert, high-risk blunt trauma patient
AU - Zabel, David D.
AU - Tinkoff, Glen
AU - Wittenborn, William
AU - Ballard, Kay
AU - Fulda, Gerard
PY - 1997/12
Y1 - 1997/12
N2 - Objective: The purpose of this study was to determine the adequacy and accuracy of lateral cervical spine radiographs in the initial evaluation of alert, high-risk trauma patients evaluated at a Level I trauma center. Methods: Data were obtained retrospectively through review of trauma service admissions from January 1, 1994, to July 31, 1995. Included were all patients triaged to a trauma response team with age > 15 years, Glasgow Coma Scale score > 13, and blunt mechanism of injury. Lateral cervical spine radiograms were obtained routinely before secondary survey and were reviewed for technical adequacy (all seven cervical vertebrae, C7/T1 interspace). The presence of cervical symptoms (pain, tenderness, neurologic deficits) was recorded. Sensitivity and specificity were calculated for lateral cervical spine radiography and cervical symptoms in predicting the presence of cervical spine injury. Bayesian analysis, which allows for the current probability of occurrence to be factored by previously reported probabilities of occurrence, was used to determine the negative predictive probability of lateral cervical spine radiography and absence of cervical symptoms to predict the absence of injury to the cervical spine. Results: Three hundred fifty-three patients received lateral cervical spine radiograms, of which 223 (63%) were determined to be adequate for interpretation. Cervical symptoms were present in 77 patients (20%). Only 32 (42%) of this group's lateral cervical spine radiograms were adequate. Nine patients (2.4%) had acutely fractured cervical vertebrae or ligamentous disruption. Lateral cervical spine radiography showed the injury in only six of these patients. The sensitivity, specificity, and negative predictive probability for lateral cervical spine radiography were 67, 58, and 1.4%, respectively, and for absence of cervical symptoms, 89, 81, and 0.32%, respectively. Conclusion: The higher accuracy and lower negative predictive probability make the absence of cervical symptoms in the alert, high-risk, blunt trauma patient a better screening test than lateral cervical spine radiography. We suggest that lateral cervical spine radiography is not needed in the initial evaluation of alert patients who have sustained blunt trauma.
AB - Objective: The purpose of this study was to determine the adequacy and accuracy of lateral cervical spine radiographs in the initial evaluation of alert, high-risk trauma patients evaluated at a Level I trauma center. Methods: Data were obtained retrospectively through review of trauma service admissions from January 1, 1994, to July 31, 1995. Included were all patients triaged to a trauma response team with age > 15 years, Glasgow Coma Scale score > 13, and blunt mechanism of injury. Lateral cervical spine radiograms were obtained routinely before secondary survey and were reviewed for technical adequacy (all seven cervical vertebrae, C7/T1 interspace). The presence of cervical symptoms (pain, tenderness, neurologic deficits) was recorded. Sensitivity and specificity were calculated for lateral cervical spine radiography and cervical symptoms in predicting the presence of cervical spine injury. Bayesian analysis, which allows for the current probability of occurrence to be factored by previously reported probabilities of occurrence, was used to determine the negative predictive probability of lateral cervical spine radiography and absence of cervical symptoms to predict the absence of injury to the cervical spine. Results: Three hundred fifty-three patients received lateral cervical spine radiograms, of which 223 (63%) were determined to be adequate for interpretation. Cervical symptoms were present in 77 patients (20%). Only 32 (42%) of this group's lateral cervical spine radiograms were adequate. Nine patients (2.4%) had acutely fractured cervical vertebrae or ligamentous disruption. Lateral cervical spine radiography showed the injury in only six of these patients. The sensitivity, specificity, and negative predictive probability for lateral cervical spine radiography were 67, 58, and 1.4%, respectively, and for absence of cervical symptoms, 89, 81, and 0.32%, respectively. Conclusion: The higher accuracy and lower negative predictive probability make the absence of cervical symptoms in the alert, high-risk, blunt trauma patient a better screening test than lateral cervical spine radiography. We suggest that lateral cervical spine radiography is not needed in the initial evaluation of alert patients who have sustained blunt trauma.
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U2 - 10.1097/00005373-199712000-00015
DO - 10.1097/00005373-199712000-00015
M3 - Article
C2 - 9420111
AN - SCOPUS:0031461441
SN - 0022-5282
VL - 43
SP - 952
EP - 958
JO - Journal of Trauma - Injury, Infection and Critical Care
JF - Journal of Trauma - Injury, Infection and Critical Care
IS - 6
ER -