Journal of Trauma and Injury

The Korean Society of Traumatology (대한외상학회)
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Predictive Factors for Cervical Spine Injury in Patients with Minor Head Injury

경증 두부 외상을 가진 환자의 경추 손상을 예측할 수 있는 관련 인자

  • Park, Chul Woo (Departments of Emergency Medicine, Masan Samsung Hospital, Sungkyunkwan University School of Medicine) ;
  • Sung, Ae Jin (Departments of Emergency Medicine, Masan Samsung Hospital, Sungkyunkwan University School of Medicine) ;
  • Lee, Jun Ho (Departments of Emergency Medicine, Masan Samsung Hospital, Sungkyunkwan University School of Medicine) ;
  • Hwang, Seong Youn (Departments of Emergency Medicine, Masan Samsung Hospital, Sungkyunkwan University School of Medicine)
  • 박철우 (성균관대학교 의과대학 마산삼성병원 응급의학교실) ;
  • 성애진 (성균관대학교 의과대학 마산삼성병원 응급의학교실) ;
  • 이준호 (성균관대학교 의과대학 마산삼성병원 응급의학교실) ;
  • 황성연 (성균관대학교 의과대학 마산삼성병원 응급의학교실)
  • Received : 2009.07.22
  • Accepted : 2009.09.20
  • Published : 2009.12.30
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Abstract

Purpose: This study aimed to determine new criteria for detecting independent factors with high sensitivity in cases of cervical spine injury. We compared the sensitivity, the specificity, and the false negative predictive value (NPV) of plain radiographs with those of computed tomography for cervical spine injury in patients with minor head injury. Methods: We retrospectively reviewed the cases of 357 patients who underwent both cervical plain radiographs and computer tomography from January 2006, to September 2008. Patients were divided into two groups: the cervical spine injury group and the no cervical spine injury group. New criteria were organized based on variables that had significant differences in the logistic regression test. Results: Among the 357 patients, 78 patients had cervical spine injuries. The average age was $43.9{\pm}15.2$ yrs old, and the male-to-female ratio was 1.90. The most common mechanism of injury was motor vehicle accidents. There was a significant difference in loss of consciousness, Glasgow Coma Scale (GCS)=14, neurologic deficit, posterior neck tenderness, and abnormality of the cervical plain radiographs between the two groups on the logistic regression test. New criteria included the above five variables. If a patient has at least variable, the area under the ROC curve of the new criteria was 0.850, and the sensitivity and the false NPV were 87.2% and 5.2%, respectively. Conclusion: New criteria included loss of consciousness, GCS=14, neurologic deficit, posterior neck tenderness, and abnormality of the cervical plain radiographs. If the patient had at least 1 variable, he or she could have a of cervical spine injury with a sensitivity of 87.2% and a false NPV of 5.2%.

Keywords

References

  1. Sanchez B, Waxman K, Jones T, Conner S, Chung R, Becerra S. Cervical spine clearance in blunt trauma: evaluation of a computed tomography-based protocol. J Trauma 2005;59:179-83 https://doi.org/10.1097/01.TA.0000171449.94650.81
  2. Gale SC, Gracias VH, Reilly PM, Schwab CW. The inefficiency of plain radiography to evaluate the cervical spine after blunt trauma. J Trauma 2005;59:1121-5
  3. Borock EC, Gabram SG, Jacobs LM, Murphy MA. A prospective analysis of a two-year experience using computed tomography as an adjunct for cervical spine clearance. J Trauma 1991;31:1001-5; discussion 5-6 https://doi.org/10.1097/00005373-199107000-00021
  4. Griffen MM, Frykberg ER, Kerwin AJ, Schinco MA, Tepas JJ, Rowe K, et al. Radiographic clearance of blunt cervical spine injury: plain radiograph or computed tomography scan? J Trauma 2003;55:222-6; discussion 6-7 https://doi.org/10.1097/01.TA.0000083332.93868.E2
  5. McCulloch PT, France J, Jones DL, Krantz W, Nguyen TP, Chambers C, et al. Helical computed tomography alone compared with plain radiographs with adjunct computed tomography to evaluate the cervical spine after high-energy trauma. J Bone Joint Surg Am 2005;87:2388-94 https://doi.org/10.2106/JBJS.E.00208
  6. Mathen R, Inaba K, Munera F, Teixeira PG, Rivas L, McKenney M, et al. Prospective evaluation of multislice computed tomography versus plain radiographic cervical spine clearance in trauma patients. J Trauma 2007;62:1427-31 https://doi.org/10.1097/01.ta.0000239813.78603.15
  7. Bach CM, Steingruber IE, Peer S, Peer-Kuhberger R, Jaschke W, Ogon M. Radiographic evaluation of cervical spine trauma. Plain radiography and conventional tomography versus computed tomography. Arch Orthop Trauma Surg 2001;121:385-7 https://doi.org/10.1007/s004020000257
  8. Schwartz DT. Emergency Radiology. Case Studies. New York: McGraw-Hill; 2008. p.364-9
  9. American College of Surgeon eds. Advanced Trauma Life Support Program for Doctors. Spine and Spinal cord Trauma. ATLS 7th eds. 2004. p.177-94
  10. MacDonald RL, Schwartz ML, Mirich D, Sharkey PW, Nelson WR. Diagnosis of cervical spine injury in motor vehicle crash victims: how many X-rays are enough? J Trauma 1990;30:392-7 https://doi.org/10.1097/00005373-199030040-00004
  11. Ross SE, Schwab CW, David ET, Delong WG, Born CT. Clearing the cervical spine: initial radiologic evaluation. J Trauma 1987;27:1055-60 https://doi.org/10.1097/00005373-198709000-00017
  12. Woodring JH, Lee C. Limitations of cervical radiography in the evaluation of acute cervical trauma. J Trauma 1993;34:32-9 https://doi.org/10.1097/00005373-199301000-00006
  13. Barba CA, Taggert J, Morgan AS, Guerra J, Bernstein B, Lorenzo M, et al. A new cervical spine clearance protocol using computed tomography. J Trauma 2001;51:652-6; discussion 6-7 https://doi.org/10.1097/00005373-200110000-00005
  14. Woodring JH, Lee C. The role and limitations of computed tomographic scanning in the evaluation of cervical trauma. J Trauma 1992;33:698-708 https://doi.org/10.1097/00005373-199211000-00019
  15. Velmahos GC, Theodorou D, Tatevossian R, Belzberg H, Cornwell EE, 3rd, Berne TV, et al. Radiographic cervical spine evaluation in the alert asymptomatic blunt trauma victim: much ado about nothing. J Trauma 1996;40:768-74 https://doi.org/10.1097/00005373-199605000-00015
  16. Stiell IG, Wells GA, Vandemheen KL, Clement CM, Lesiuk H, De Maio VJ, et al. The Canadian C-spine rule for radiography in alert and stable trauma patients. JAMA 2001;286:1841-8 https://doi.org/10.1001/jama.286.15.1841
  17. Stiell IG, Clement CM, McKnight RD, Brison R, Schull MJ, Rowe BH, et al. The Canadian C-spine rule versus the NEXUS low-risk criteria in patients with trauma. N Engl J Med 2003;349:2510-8 https://doi.org/10.1056/NEJMoa031375
  18. Duane TM, Dechert T, Wolfe LG, Aboutanos MB, Malhotra AK, Ivatury RR. Clinical examination and its reliability in identifying cervical spine fractures. J Trauma 2007;62:1405-8; discussion 8-10 https://doi.org/10.1097/TA.0b013e31804798d5
  19. Patton JH, Kralovich KA, Cuschieri J, Gasparri M. Clearing the cervical spine in victims of blunt assault to the head and neck: what is necessary? Am Surg 2000;66:326-30; discussion 30-1