Prospective Evaluation of Multislice Computed Tomography Versus Plain Radiographic Cervical Spine Clearance in Trauma Patients

Abstract

The objective of this study was to compare the utility of plain radiographs to multislice computed tomography (MCT) for cervical spine (c-spine) evaluation. We hypothesized that plain radiographs add no clinically relevant diagnostic information to MCT in the screening evaluation of the c-spine of trauma patients. This was a prospective, unblinded, consecutive series of injured patients requiring c-spine evaluation that were imaged with three-view plain films and MCT (occiput to T1 with 3-dimensional reconstruction). The final discharge diagnosis based on all prospectively collected clinical data, MCT, and plain films was utilized as the gold standard for the sensitivity calculation. From October 2004 to February 2005, 667 trauma patients requiring c-spine evaluation were enrolled. Average age was 35.4 years and 70% were male. The mechanism of injury was blunt in 99% and 48.7% occurred as a result of motor vehicle collision. Sixty of 667 (9%) sustained acute c-spine injuries. MCT had a sensitivity of 100% and specificity of 99.5%. Plain films had a sensitivity of 45% and specificity of 97.4%. Plain radiography missed 15 of 27 (55.5%) clinically significant c-spine injuries. MCT outperformed plain radiography as a screening modality for the identification of acute c-spine injury in trauma patients. All clinically significant injuries were detected by MCT. Plain films failed to identify 55.5% of clinically significant fractures identified by MCT and added no clinically relevant information.