BACKGROUND: A true gold standard to rule out a significant cervical spine injury in subset of blunt trauma patients with altered sensorium is still to be agreed upon. The objective of this study is to determine whether in obtunded adult patients with blunt trauma, a clinically significant injury to the cervical spine be ruled out on the basis of a normal multidetector cervical spine computed tomography. METHODS: Comprehensive database search was conducted to include all the prospective and retrospective studies on blunt trauma patients with altered sensorium undergoing cervical spine multidetector CT scan as core imaging modality to "clear" the cervical spine. The studies used two main gold standards, magnetic resonance imaging of the cervical spine and/or prolonged clinical follow-up. The data was extracted to report true positive, true negatives, false positives and false negatives. Meta-analysis of sensitivity, specificity, negative and positive predictive values was performed using Meta Analyst Beta 3.13 software. We also performed a retrospective investigation comparing a robust clinical follow-up and/or cervical spine MR findings in 53 obtunded blunt trauma patients, who previously had undergone a normal multidetector CT scan of the cervical spine reported by a radiologist. RESULTS: A total of 10 studies involving 1850 obtunded blunt trauma patients with initial cervical spine CT scan reported as normal were included in the final meta-analysis. The cumulative negative predictive value and specificity of cervical spine CT of the ten studies was 99.7% (99.4-99.9%, 95% confidence interval). The positive predictive value and sensitivity was 93.7% (84.0-97.7%, 95% confidence interval). In the retrospective review of our obtunded blunt trauma patients, none was later diagnosed to have significant cervical spine injury that required a change in clinical management. CONCLUSION: In a blunt trauma patient with altered sensorium, a normal cervical spine CT scan is conclusive to safely rule out a clinically significant cervical spine injury. The results of this meta-analysis strongly support the removal of cervical precautions in obtunded blunt trauma patient after normal cervical spine computed tomography. Any further imaging like magnetic resonance imaging of the cervical spine should be performed on case-to-case basis.
BACKGROUND: A true gold standard to rule out a significant cervical spine injury in subset of blunt traumapatients with altered sensorium is still to be agreed upon. The objective of this study is to determine whether in obtunded adult patients with blunt trauma, a clinically significant injury to the cervical spine be ruled out on the basis of a normal multidetector cervical spine computed tomography. METHODS: Comprehensive database search was conducted to include all the prospective and retrospective studies on blunt traumapatients with altered sensorium undergoing cervical spine multidetector CT scan as core imaging modality to "clear" the cervical spine. The studies used two main gold standards, magnetic resonance imaging of the cervical spine and/or prolonged clinical follow-up. The data was extracted to report true positive, true negatives, false positives and false negatives. Meta-analysis of sensitivity, specificity, negative and positive predictive values was performed using Meta Analyst Beta 3.13 software. We also performed a retrospective investigation comparing a robust clinical follow-up and/or cervical spine MR findings in 53 obtunded blunt traumapatients, who previously had undergone a normal multidetector CT scan of the cervical spine reported by a radiologist. RESULTS: A total of 10 studies involving 1850 obtunded blunt traumapatients with initial cervical spine CT scan reported as normal were included in the final meta-analysis. The cumulative negative predictive value and specificity of cervical spine CT of the ten studies was 99.7% (99.4-99.9%, 95% confidence interval). The positive predictive value and sensitivity was 93.7% (84.0-97.7%, 95% confidence interval). In the retrospective review of our obtunded blunt traumapatients, none was later diagnosed to have significant cervical spine injury that required a change in clinical management. CONCLUSION: In a blunt traumapatient with altered sensorium, a normal cervical spine CT scan is conclusive to safely rule out a clinically significant cervical spine injury. The results of this meta-analysis strongly support the removal of cervical precautions in obtunded blunt traumapatient after normal cervical spine computed tomography. Any further imaging like magnetic resonance imaging of the cervical spine should be performed on case-to-case basis.
Authors: Kenji Inaba; Saskya Byerly; Lisa D Bush; Matthew J Martin; David T Martin; Kimberly A Peck; Galinos Barmparas; Matthew J Bradley; Joshua P Hazelton; Raul Coimbra; Asad J Choudhry; Carlos V R Brown; Chad G Ball; Jill R Cherry-Bukowiec; Clay Cothren Burlew; Bellal Joseph; Julie Dunn; Christian T Minshall; Matthew M Carrick; Gina M Berg; Demetrios Demetriades Journal: J Trauma Acute Care Surg Date: 2016-12 Impact factor: 3.313
Authors: Laura A Galganski; Jessica A Cox; David G Greenhalgh; Soman Sen; Kathleen S Romanowski; Tina L Palmieri Journal: J Burn Care Res Date: 2019-04-26 Impact factor: 1.845
Authors: Justin M Moore; Jonathan Hall; Michael Ditchfield; Christopher Xenos; Andrew Danks Journal: Childs Nerv Syst Date: 2016-12-06 Impact factor: 1.475
Authors: Mayur B Patel; Stephen S Humble; Daniel C Cullinane; Matthew A Day; Randeep S Jawa; Clinton J Devin; Margaret S Delozier; Lou M Smith; Miya A Smith; Jeannette M Capella; Andrea M Long; Joseph S Cheng; Taylor C Leath; Yngve Falck-Ytter; Elliott R Haut; John J Como Journal: J Trauma Acute Care Surg Date: 2015-02 Impact factor: 3.313
Authors: Annelie Slaar; M M Fockens; Junfeng Wang; Mario Maas; David J Wilson; J Carel Goslings; Niels Wl Schep; Rick R van Rijn Journal: Cochrane Database Syst Rev Date: 2017-12-07