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A systematic review of the need for MRI for the clearance of cervical spine injury in obtunded blunt trauma patients after normal cervical spine CT.

James IA, Moukalled A, Yu E, Tulman DB, Bergese SD, Jones CD, Stawicki SP, Evans DC - J Emerg Trauma Shock (2014)

Bottom Line: The abnormalities reported on CS-MRI resulted in prolonged rigid c-collar immobilization in 74 patients (4.9%).Eleven patients (0.7%) had unstable injury detected on CS-MRI alone that required surgical intervention.However, when a reliable clinical exam reveals intact gross motor function, CS-MRI may be unnecessary.

View Article: PubMed Central - PubMed

Affiliation: Department of Surgery, Division of Trauma, Critical Care and Burn, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA.

ABSTRACT
Clearance of cervical spine injury (CSI) in the obtunded or comatose blunt trauma patient remains controversial. In patients with unreliable physical examination and no evidence of CSI on computed tomography (CT), magnetic resonance imaging of the cervical spine (CS-MRI) is the typical follow-up study. There is a growing body of evidence suggesting that CS-MRI is unnecessary with negative findings on a multi-detector CT (MDCT) scan. This review article systematically analyzes current literature to address the controversies surrounding clearance of CSI in obtunded blunt trauma patients. A literature search through MEDLINE database was conducted using all databases on the National Center for Biotechnology Information (NCBI) website (www.ncbi.nlm.nih.gov) for keywords: "cervical spine injury," "obtunded," and "MRI." The search was limited to studies published within the last 10 years and with populations of patients older than 18 years old. Eleven studies were included in the analysis yielding data on 1535 patients. CS-MRI detected abnormalities in 256 patients (16.6%). The abnormalities reported on CS-MRI resulted in prolonged rigid c-collar immobilization in 74 patients (4.9%). Eleven patients (0.7%) had unstable injury detected on CS-MRI alone that required surgical intervention. In the obtunded blunt trauma patient with unreliable clinical examination and a normal CT scan, there is still a role for CS-MRI in detecting clinically significant injuries when MRI resources are available. However, when a reliable clinical exam reveals intact gross motor function, CS-MRI may be unnecessary.

No MeSH data available.


Related in: MedlinePlus

Evaluations, results, and interventions in included patients. CS-CT: Cervical spine computed tomography; CS-MRI: Cervical spine magnetic resonance imaging
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Figure 2: Evaluations, results, and interventions in included patients. CS-CT: Cervical spine computed tomography; CS-MRI: Cervical spine magnetic resonance imaging

Mentions: The search yielded 44 PubMed scientific and medical abstracts, 83 PubMed Central full text journal articles, 5 book reports and 5 PubMed health clinical effectiveness, disease and drug report for a total of 137 articles [Figure 1]. Limitations of the 137 articles to publication date within the last 10 years and/or adult population and the English language resulted in 63 articles. Eleven of these articles met the inclusion criteria, yielding data on a total of 1,535 patients [Figure 2]. Descriptions of the 11 studies are listed in Tables 2 and 3.


A systematic review of the need for MRI for the clearance of cervical spine injury in obtunded blunt trauma patients after normal cervical spine CT.

James IA, Moukalled A, Yu E, Tulman DB, Bergese SD, Jones CD, Stawicki SP, Evans DC - J Emerg Trauma Shock (2014)

Evaluations, results, and interventions in included patients. CS-CT: Cervical spine computed tomography; CS-MRI: Cervical spine magnetic resonance imaging
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4231259&req=5

Figure 2: Evaluations, results, and interventions in included patients. CS-CT: Cervical spine computed tomography; CS-MRI: Cervical spine magnetic resonance imaging
Mentions: The search yielded 44 PubMed scientific and medical abstracts, 83 PubMed Central full text journal articles, 5 book reports and 5 PubMed health clinical effectiveness, disease and drug report for a total of 137 articles [Figure 1]. Limitations of the 137 articles to publication date within the last 10 years and/or adult population and the English language resulted in 63 articles. Eleven of these articles met the inclusion criteria, yielding data on a total of 1,535 patients [Figure 2]. Descriptions of the 11 studies are listed in Tables 2 and 3.

Bottom Line: The abnormalities reported on CS-MRI resulted in prolonged rigid c-collar immobilization in 74 patients (4.9%).Eleven patients (0.7%) had unstable injury detected on CS-MRI alone that required surgical intervention.However, when a reliable clinical exam reveals intact gross motor function, CS-MRI may be unnecessary.

View Article: PubMed Central - PubMed

Affiliation: Department of Surgery, Division of Trauma, Critical Care and Burn, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA.

ABSTRACT
Clearance of cervical spine injury (CSI) in the obtunded or comatose blunt trauma patient remains controversial. In patients with unreliable physical examination and no evidence of CSI on computed tomography (CT), magnetic resonance imaging of the cervical spine (CS-MRI) is the typical follow-up study. There is a growing body of evidence suggesting that CS-MRI is unnecessary with negative findings on a multi-detector CT (MDCT) scan. This review article systematically analyzes current literature to address the controversies surrounding clearance of CSI in obtunded blunt trauma patients. A literature search through MEDLINE database was conducted using all databases on the National Center for Biotechnology Information (NCBI) website (www.ncbi.nlm.nih.gov) for keywords: "cervical spine injury," "obtunded," and "MRI." The search was limited to studies published within the last 10 years and with populations of patients older than 18 years old. Eleven studies were included in the analysis yielding data on 1535 patients. CS-MRI detected abnormalities in 256 patients (16.6%). The abnormalities reported on CS-MRI resulted in prolonged rigid c-collar immobilization in 74 patients (4.9%). Eleven patients (0.7%) had unstable injury detected on CS-MRI alone that required surgical intervention. In the obtunded blunt trauma patient with unreliable clinical examination and a normal CT scan, there is still a role for CS-MRI in detecting clinically significant injuries when MRI resources are available. However, when a reliable clinical exam reveals intact gross motor function, CS-MRI may be unnecessary.

No MeSH data available.


Related in: MedlinePlus