Shevonne S Satahoo1, James S Davis1, George D Garcia1, Salman Alsafran1, Reeni K Pandya1, Cheryl D Richie1, Fahim Habib1, Luis Rivas2, Nicholas Namias1, Carl I Schulman3. 1. Division of Trauma and Critical Care, DeWitt Daughtry Department of Surgery, Jackson Memorial Hospital/University of Miami - Miller School of Medicine, Miami, Florida. 2. Department of Radiology, Jackson Memorial Hospital/University of Miami - Miller School of Medicine, Miami, Florida. 3. Division of Trauma and Critical Care, DeWitt Daughtry Department of Surgery, Jackson Memorial Hospital/University of Miami - Miller School of Medicine, Miami, Florida. Electronic address: cschulman@med.miami.edu.
Abstract
BACKGROUND: Evaluating the cervical spine in the obtunded trauma patient is a subject fraught with controversy. Some authors assert that a negative computed tomography (CT) scan is sufficient. Others argue that CT alone misses occult unstable injuries, and magnetic resonance imaging (MRI) will alter treatment. This study examines the data in an urban, county trauma center to determine if a negative cervical spine CT scan is sufficient to clear the obtunded trauma patient. METHODS: Records of all consecutive patients admitted to a level 1 trauma center from January 2000 to December 2011 were retrospectively analyzed. Patients directly admitted to the intensive care unit with a Glasgow Coma Scale score ≤13, contemporaneous CT and MRI, and a negative CT reading were included. The results of the cervical spine MRI were analyzed. RESULTS: A total of 309 patients had both CT and MRI, 107 (35%) of whom had negative CTs. Mean time between CT and MRI was 16 d. Of those patients, seven (7%) had positive acute traumatic findings on MRI. Findings included ligamentous injury, subluxation, and fracture. However, only two of these patients required surgical intervention. None had unstable injuries. CONCLUSIONS: In the obtunded trauma patient with a negative cervical spine CT, obtaining an MRI does not appear to significantly alter management, and no unstable injuries were missed on CT scan. This should be taken into consideration given the current efforts at cost-containment in the health care system. It is one of the larger studies published to date.
BACKGROUND: Evaluating the cervical spine in the obtunded traumapatient is a subject fraught with controversy. Some authors assert that a negative computed tomography (CT) scan is sufficient. Others argue that CT alone misses occult unstable injuries, and magnetic resonance imaging (MRI) will alter treatment. This study examines the data in an urban, county trauma center to determine if a negative cervical spine CT scan is sufficient to clear the obtunded traumapatient. METHODS: Records of all consecutive patients admitted to a level 1 trauma center from January 2000 to December 2011 were retrospectively analyzed. Patients directly admitted to the intensive care unit with a Glasgow Coma Scale score ≤13, contemporaneous CT and MRI, and a negative CT reading were included. The results of the cervical spine MRI were analyzed. RESULTS: A total of 309 patients had both CT and MRI, 107 (35%) of whom had negative CTs. Mean time between CT and MRI was 16 d. Of those patients, seven (7%) had positive acute traumatic findings on MRI. Findings included ligamentous injury, subluxation, and fracture. However, only two of these patients required surgical intervention. None had unstable injuries. CONCLUSIONS: In the obtunded traumapatient with a negative cervical spine CT, obtaining an MRI does not appear to significantly alter management, and no unstable injuries were missed on CT scan. This should be taken into consideration given the current efforts at cost-containment in the health care system. It is one of the larger studies published to date.
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: Mohamed A Mohamed; Karl D Majeske; Gul Sachwani-Daswani; Daniel Coffey; Karim M Elghawy; Amanda Pham; Donald Scholten; Kenneth L Wilson; Leo Mercer; Michael L McCann Journal: Trauma Surg Acute Care Open Date: 2016-10-19