Kokabi Nima, Raper Daniel M S, Xing Minzhi, Giuffre Bruno Mario
Northern Clinical School, Royal North Shore Hospital, University of Sydney, Reserve Road, St Leonards, NSW 2065, Australia.
Emerg Radiol. 2011 Jan;18(1):31-8. doi: 10.1007/s10140-010-0901-z. Epub 2010 Aug 31.
Safe and efficient clearance of cervical spine injury in blunt trauma patients has been a controversial topic among health professionals. The increased availability of CT scanners in major trauma centers seems to be a factor that has led to increased number of unnecessary cervical spine imaging using this imaging modality. The objective of this study was to investigate the applicability and efficacy of a pre-test clinical criterion in order to stratify post-blunt trauma victims based on their risk of sustaining cervical spine injury and in turn recommend an appropriate imaging modality accordingly. Goergen's criteria (Australas Radiol 48(3):287, 2004), a pre-investigation diagnostic algorithm was retrospectively applied to 106 blunt trauma victims who presented to a level 1 trauma center in Sydney, Australia, and had a CT scan of cervical spine as part of their initial management. Overall, nine (8.5%) of patients sustained a significant cervical spine injury. All nine patients would be classified as high-risk victims according to the algorithm investigated in this study, warranting CT scanning. No patients with low-risk injuries were demonstrated to have a significant cervical spine injury. There was a statistically significant greater proportion of acute cervical spine injuries detected in the high-risk group (p value = 0.0024). Hence, using Goergen's diagnostic algorithm could reduce the number of unnecessary cervical spine CT scans ordered, while not compromising the quality of care in post-blunt trauma victims.
在钝性创伤患者中安全有效地排除颈椎损伤一直是医疗专业人员之间存在争议的话题。主要创伤中心CT扫描仪的可及性增加似乎是导致使用这种成像方式进行不必要颈椎成像数量增加的一个因素。本研究的目的是调查一种预测试临床标准的适用性和有效性，以便根据钝性创伤受害者遭受颈椎损伤的风险对其进行分层，进而相应地推荐合适的成像方式。Goergen标准（《澳大利亚放射学》48(3):287, 2004），一种调查前诊断算法，被回顾性应用于106名钝性创伤受害者，这些受害者就诊于澳大利亚悉尼的一家一级创伤中心，并在其初始治疗中进行了颈椎CT扫描。总体而言，9名（8.5%）患者遭受了严重的颈椎损伤。根据本研究中调查的算法，所有9名患者都将被归类为高危受害者，需要进行CT扫描。没有低风险损伤的患者被证明有严重的颈椎损伤。高危组中检测到的急性颈椎损伤比例在统计学上显著更高（p值 = 0.0024）。因此，使用Goergen诊断算法可以减少不必要的颈椎CT扫描数量，同时不影响钝性创伤受害者的护理质量。
