Department of Radiology, Henry Ford Health System, 2799 W Grand Blvd, Detroit, MI 48202, USA.
AJR Am J Roentgenol. 2011 Aug;197(2):463-7. doi: 10.2214/AJR.10.5731.
The objective of our study was to analyze the use of screening cervical spine CT performed after trauma and establish the opportunity of potentially avoidable studies when evidence-based clinical criteria are applied before imaging.
All cervical spine CT examinations performed in the emergency department of a level 1 trauma center between January and December 2008 on adult patients with trauma were analyzed; 1589 studies were evaluated. Radiology reports and clinical data were reviewed for the presence of fracture or ligamentous injury and for the mode of injury. We also looked for documentation of clinical criteria used to perform the CT study. In particular, we looked for mention of posterior midline cervical tenderness, focal neurologic deficit, level of alertness, evidence of intoxication, and clinically apparent distracting injury. These five criteria were established by the National Emergency X-Radiography Utilization Study (NEXUS) to identify patients with a low probability of cervical spine injury who consequently needed no cervical spine imaging.
Of the 1589 studies reviewed, 41 (2.6%) were positive for an acute cervical spine injury and 1524 (95.9%) were negative. The remaining 24 studies (1.5%) were indeterminate on the initial CT examination but subsequent imaging and clinical follow-up failed to show acute injury. Of the 1524 examinations with no acute injury, 364 (23.9%) had no documentation of any of the five NEXUS low-risk criteria.
The strict application of the NEXUS low-risk criteria could potentially reduce the number of screening cervical spine CT examinations in the setting of trauma in more than 20% of cases, thereby avoiding a significant amount of unnecessary radiation and significant cost.
本研究旨在分析创伤后进行颈椎 CT 筛查的应用情况，并在应用基于循证临床标准进行影像学检查之前，确定潜在可避免的检查机会。
分析 2008 年 1 月至 12 月期间在一家 1 级创伤中心的急诊科进行的所有成年创伤患者颈椎 CT 检查；共评估了 1589 项研究。回顾放射学报告和临床数据，以确定是否存在骨折或韧带损伤，以及损伤方式。我们还寻找了用于进行 CT 研究的临床标准的记录。特别是，我们寻找了颈椎后正中线压痛、局灶性神经功能缺损、警觉水平、中毒证据和明显的外伤性移位这 5 项标准的记录。这 5 项标准是由国家急诊 X 射线利用研究（NEXUS）确定的，用于识别颈椎损伤可能性较低的患者，这些患者无需进行颈椎成像。
在 1589 项研究中，41 项（2.6%）为急性颈椎损伤阳性，1524 项（95.9%）为阴性。其余 24 项（1.5%）在初始 CT 检查时不确定，但后续影像学和临床随访均未显示急性损伤。在 1524 项无急性损伤的检查中，有 364 项（23.9%）没有任何 NEXUS 低危标准的记录。
严格应用 NEXUS 低危标准可使创伤后颈椎筛查 CT 检查的数量减少 20%以上，从而避免大量不必要的辐射和显著的费用。
