Can CT eliminate the initial portable lateral cervical spine radiograph in the multiple trauma patient? A review of 200 cases

Abstract

Purpose: This investigation examines whether there is a continued role for the initial screening lateral portable radiograph in patients whose cervical spine is “cleared” by a CT examination. Methods: A retrospective review of 200 multiple trauma patients suspected of cervical spine injury (CSI) was performed. All patients had a screening lateral portable cervical spine radiograph (LPCSR) followed by cervical spine CT (CSCT). All scans were helical and included coronal and sagittal reformations. Reports of both examinations were compared for all patients. For those patients with signs of acute CSI, the two reports were compared to determine whether the LPCSR contained any information affecting patient outcome that was not detected by CSCT. Results: The CSCT showed no signs of acute CSI injury in 190 patients. Ten CSCT scans showed signs of fracture. In these 10 patients, the screening LPSCR showed signs of fracture in 1 patient, question of fracture in 2 patients, and no fracture in 7 patients. No LPCSR demonstrated significant information not seen on the accompanying CSCT. No LPSCR showed a finding that altered patient management prior to CSCT. Conclusion: The data suggest that an initial LPCSR is unnecessary if the patient is having a screening CSCT.