Utilization of computerized tomography and magnetic resonance imaging for diagnosis of traumatic C-Spine injuries at a level 1 trauma center: A retrospective Cohort analysis. (August 2021)

• Record Type: Journal Article
• Authors: Sutherland, Mason; Bourne, Mitchell; McKenney, Mark; Elkbuli, Adel
• Is Part Of: Annals of medicine and surgery. Volume 68(2021)
• Publication Date: 2021-08
• Subjects: Blunt injuries -- C-Spine injuries -- Computed tomography -- Magnetic resonance imaging -- Trauma outcomes; Surgery -- Periodicals; Medicine -- Periodicals; General Surgery -- Periodicals; Education, Medical -- Periodicals; Periodicals; 617
• DOI: 10.1016/j.amsu.2021.102566
• Languages: English
• ISSNs: 2049-0801

Abstract

Abstract: Background: Computerized tomography (CT) is a common imaging modality for trauma patients, but there is debate regarding the role of magnetic resonance imaging (MRI) in cervical (C)-spine clearance. We aim to investigate the utilization of CT and MRI imaging in traumatic C-spine clearance and associated outcomes on patients who undergo both imaging modalities. Methods: A 4-year retrospective review was performed to evaluate the trauma patient imaging algorithm at our institution. The algorithm required CT as a screening examination for traumatic injury patients who are unexaminable because of distracting injury, altered mental status, an abnormal neurological examination, and/or central neck pain. MRI was performed after CT in patients with C-spine injuries identified on CT, those who remained unexaminable, had an abnormal neurological examination, or experienced persistent central neck tenderness. Univariate analyses and adjusted multivariate logistic regression were performed with significance defined as p < 0.05. Results: 805 patients were analyzed. Compared to MRI, CT had a sensitivity of 50.2%, specificity of 76.6%, positive predictive value of 69.7%, and negative predictive value of 59.0% in detecting C-spine injuries. CT and MRI differed significantly in their ability to detect C-spine soft tissue injuries and C1 vertebral fractures (p < 0.05). Conclusions: MRI is more capable of detecting soft tissue injuries whereas CT is superior in detecting vertebral fractures. Our findings support the need to utilize CT and MRI in conjunction to detect both bony and soft tissue C-spine injuries in traumatically injured patients, who are either unexaminable, have an abnormal neurologic examination, or ongoing central neck tenderness. Highlights: Sensitivity & specificity of Computed Tomography (CT) for cervical spine C1–C7 vertebral fracture was 85.4% and 96.1%. Negative & positive predictive value of CT for cervical spine C1–C7 vertebral fracture was 95.7% and 86.8%. CT was superior to Magnetic Resonance Imaging (MRI) in the detection of C1 vertebral fracture (p = 0.006). Odds of mortality were higher for unexaminable patients and those with severe injury severity score (p < 0.05). Modification of guidelines to recommend MRI for stable patients who are neurologically unexaminable maybe needed.