Prospective evaluation of computed tomographic scanning for the spinal clearance of obtunded trauma patients: Preliminary results

Background: Screening methods for detecting cervical spine injury in obtunded ventilated patients continue to evolve. This study compared the use of plain radiography to computed tomographic (CT) scanning of cervical spines in the obtunded blunt trauma patient. The accuracy of plain radiography and CT scanning in detecting clinically significant cervical spine injury in the obtunded blunt trauma patient was evaluated. Methods: We conducted a prospective cohort study with a 3-year convenience sample. The study population consisted of a high-risk subpopulation of severely injured patients, intubated or with a Glasgow Coma Scale score < 9 at presentation. Patients were assessed with a three-view cervical spine series and a CT scan of their cervical spines from the skull base to T1. Independent-blinded review of plain radiographs and CT scans was performed by two radiologists. Sensitivity, specificity, and accuracy of plain films were compared with CT scanning. Sensitivity of CT scanning was compared with discharge diagnosis of cervical spine or cord injury. Results: One hundred two patients were eligible and underwent three-view plain radiography and CT scanning. Sensitivity, specificity, and accuracy of plain films compared with CT scanning were 39%, 98%, and 88%, respectively. CT scanning was 100% sensitive in detecting cervical spine injury. Conclusion: CT scanning in conjunction with plain films enhances the number of cervical spine injuries seen radiographically. Application of a protocol of plain radiographs and CT scanning may be used to clear cervical spines in the obtunded trauma patient. Ongoing evaluation of this protocol is required.