Department of Orthopedic Surgery and Rehabilitation, University of Wisconsin, Madison, WI 53792, USA.
J Orthop Trauma. 2010 Feb;24(2):100-6. doi: 10.1097/BOT.0b013e3181b16494.
To perform a comprehensive review of the literature and subsequent meta-analysis of data regarding appropriate clearance of the asymptomatic cervical spine in blunt trauma patients. The goal is to identify an asymptomatic patient group that can safely be cleared of cervical spine immobilization without radiographic evaluation.
The National Library of Medicine was searched for English-language articles published between 1966 and December 2004. The key words spinal injury, spinal fracture, spinal injuries, cervical, clearance, diagnosis, and radiography were used to perform the search.
Inclusion criteria were 1) a prospectively applied protocol; 2) reported outcomes to allow calculation of sensitivity, specificity, negative predictive value, and positive predictive value; and 3) follow up to determine the status of potential injuries with minimum of a 2-week telephone call or a computerized tomography scan. No exclusion criteria were applied.
The three senior authors independently confirmed the validity of the included papers for meeting appropriate criteria for the meta-analysis. True-positives, true-negatives, false-positives, and false-negatives were extracted from these studies.
Original scale and log odds meta-analysis were performed using random effects methodology to calculate sensitivity, specificity, positive predictive value, and negative predictive value.
An alert, asymptomatic patient without a distracting injury or neurologic deficit who is able to complete a functional range-of-motion examination may safely be cleared from cervical spine immobilization without radiographic evaluation (sensitivity = 98.1%, negative predictive value = 99.8%).
对钝性创伤患者无症状颈椎间隙清除的文献进行全面回顾和随后的数据荟萃分析。目的是确定一个无症状的患者群体，他们可以安全地从颈椎固定中清除，而无需进行影像学评估。
美国国立医学图书馆（National Library of Medicine）检索了 1966 年至 2004 年 12 月期间发表的英文文章。使用“脊柱损伤、脊柱骨折、脊柱损伤、颈椎、清除、诊断、放射摄影”等关键词进行搜索。
纳入标准为 1）前瞻性应用方案；2）报告的结果允许计算敏感性、特异性、阴性预测值和阳性预测值；3）随访以确定潜在损伤的状态，最低限度是 2 周的电话或计算机断层扫描。没有应用排除标准。
三位资深作者独立确认纳入论文符合荟萃分析适当标准的有效性。从这些研究中提取真阳性、真阴性、假阳性和假阴性。
使用随机效应方法进行原始量表和对数优势荟萃分析，以计算敏感性、特异性、阳性预测值和阴性预测值。
一个警觉、无症状的患者，没有分散注意力的损伤或神经功能缺损，能够完成功能范围运动检查，可以安全地从颈椎固定中清除，而无需进行影像学评估（敏感性=98.1%，阴性预测值=99.8%）。
