Hussein D Kanji1, Andrew Neitzel2, Mypinder Sekhon2, Jessica McCallum3, Donald E Griesdale4. 1. Department of Medicine, Division of Critical Care Medicine, University of British Columbia, Vancouver, BC, Canada; Department of Emergency Medicine, Fraser Health Region, New Westminster, BC, Canada. Electronic address: hdkanji@gmail.com. 2. Department of Medicine, Division of Critical Care Medicine, University of British Columbia, Vancouver, BC, Canada. 3. Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada. 4. Department of Medicine, Division of Critical Care Medicine, University of British Columbia, Vancouver, BC, Canada; Department of Anesthesiology, Pharmacology & Therapeutics, University of British Columbia, Vancouver, BC, Canada; Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada.
Abstract
PURPOSE: Cervical spine (CS) injury in blunt trauma is a prevalent and devastating complication. Clearing CS injuries in obtunded patients is fraught with challenges, and no single imaging modality or algorithm is both safe and effective. Increased time in c-spine precautions is associated with greater patient morbidity including increased ventilator associated pneumonia, delirium and ulceration. We systemically reviewed the literature to assess the effectiveness of 64-slice computed tomographic (CT) scanners in clearing traumatic CS injuries. MATERIALS AND METHODS: Studies were identified using MEDLINE and Embase, the references of identified studies, international experts on CS clearance and authors of primary studies. Three reviewers independently selected and extracted data from studies that reported on both CT and MRI in traumatic CS injury. RESULTS: We included five studies involving a total of 3443 patients; however, heterogeneity and lack of sample size precluded quantitative summation of the results. Qualitative assessment showed that 64-Slice CT scan, when applied within a set protocol, performed favourably in clearing injury. CONCLUSIONS: Data suggests that using 64-slice CT scans on obtunded trauma patients with grossly intact motor function, in the context of a defined clearance protocol with interpretation by an experienced radiologist, may be sufficient to safely clear significant CS injury. A prospective study comparing MRI and 64-slice CT scan clearance in this population is necessary to corroborate these conclusions.
PURPOSE: Cervical spine (CS) injury in blunt trauma is a prevalent and devastating complication. Clearing CS injuries in obtunded patients is fraught with challenges, and no single imaging modality or algorithm is both safe and effective. Increased time in c-spine precautions is associated with greater patient morbidity including increased ventilator associated pneumonia, delirium and ulceration. We systemically reviewed the literature to assess the effectiveness of 64-slice computed tomographic (CT) scanners in clearing traumatic CS injuries. MATERIALS AND METHODS: Studies were identified using MEDLINE and Embase, the references of identified studies, international experts on CS clearance and authors of primary studies. Three reviewers independently selected and extracted data from studies that reported on both CT and MRI in traumatic CS injury. RESULTS: We included five studies involving a total of 3443 patients; however, heterogeneity and lack of sample size precluded quantitative summation of the results. Qualitative assessment showed that 64-Slice CT scan, when applied within a set protocol, performed favourably in clearing injury. CONCLUSIONS: Data suggests that using 64-slice CT scans on obtunded traumapatients with grossly intact motor function, in the context of a defined clearance protocol with interpretation by an experienced radiologist, may be sufficient to safely clear significant CS injury. A prospective study comparing MRI and 64-slice CT scan clearance in this population is necessary to corroborate these conclusions.
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