Abstract
Background Cervical spine fracture is approximately 2%–5%. Diagnostic imaging in developing countries has several limitations. A computed tomography scan is not available 24 hours and not cost-effective. This study aims to develop a clinical tool to identify patients who must undergo a computed tomography scan to evaluate cervical spine fracture in a noncomputed tomography scan available hospital. Methods The study was a diagnostic prediction rule. A retrospective cross-sectional study was conducted between August 1, 2016, and December 31, 2018, at the emergency department. This study included all patients aged over 16 years who had suspected cervical spine injury and underwent a computed tomography scan at the emergency department. The predictive model and prediction scores were developed via multivariable logistic regression analysis. Results 375 patients met the criteria. 29 (7.73%) presented with cervical spine fracture on computed tomography scan and 346 did not. Five independent factors (i.e., high-risk mechanism of injury, paraparesis, paresthesia, limited range of motion of the neck, and associated chest or facial injury) were considered good predictors of C-spine fracture. The clinical prediction score for C-spine fracture was developed by dividing the patients into three probability groups (low, 0; moderate, 1–5; and high, 6–11), and the accuracy was 82.52%. In patients with a score of 1–5, the positive likelihood ratio for C-spine fracture was 1.46. Meanwhile, those with a score of 6–11 had an LR+ of 7.16. Conclusion In a noncomputed tomography scan available hospital, traumatic spine injuries patients with a clinical prediction score ≥1 were associated with cervical spine fracture and should undergo computed tomography scan to evaluate C-spine fracture.
Highlights
® Trauma Life Support (ATLS) recommends the use of the National Emergency X-Radiography Utilization Study (NEXUS) [2] criteria and the Canadian C-spine Rule (CCR) [3], which are two clinical decision tools used by clinicians in identifying patients with a lower risk for clinically important C-spine injury. erefore, the use of imaging modalities and cervical motion restriction equipment will no longer be required [1, 4, 5]. e NEXUS criteria’ sensitivity and specificity are 0.83–1.00 and 0.02–0.46, respectively, and the positive and negative predictive values are 1.44 and 0.3, respectively
Our study was conducted in a super tertiary care facility, and each patient with traumatic neck injury underwent emergency C-spine Computed tomography (CT) scan
7.73% of the patients presented with C-spine fracture on CT scan. e significant clinical predictors for C-spine fracture were the NEXUS [3] and CCR [4]
Summary
Is study aims to develop a clinical tool to identify patients who must undergo a computed tomography scan to evaluate cervical spine fracture in a noncomputed tomography scan available hospital. Is study included all patients aged over 16 years who had suspected cervical spine injury and underwent a computed tomography scan at the emergency department. E clinical prediction score for C-spine fracture was developed by dividing the patients into three probability groups (low, 0; moderate, 1–5; and high, 6–11), and the accuracy was 82.52%. In patients with a score of 1–5, the positive likelihood ratio for C-spine fracture was 1.46. In a noncomputed tomography scan available hospital, traumatic spine injuries patients with a clinical prediction score ≥1 were associated with cervical spine fracture and should undergo computed tomography scan to evaluate C-spine fracture
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