计算机断层扫描成像在地面跌落创伤评估中对颈椎的应用价值。
Utility of computed tomographic imaging of the cervical spine in trauma evaluation of ground-level fall.
作者信息
Benayoun Marc D, Allen Jason W, Lovasik Brendan P, Uriell Matthew L, Spandorfer Robert M, Holder Chad A
机构信息
From the Departments of Radiology and Imaging Sciences (M.D.B., J.W.A., M.U., C.A.H.), and Neurology (J.W.A.), School of Medicine (M.D.B., J.W.A., B.P.L., M.U., R.M.S., C.A.H.), Emory University, Atlanta, Georgia.
出版信息
J Trauma Acute Care Surg. 2016 Aug;81(2):339-44. doi: 10.1097/TA.0000000000001073.
BACKGROUND
Computed tomography (CT) of the cervical spine (C-spine) is routinely ordered for low-risk mechanisms of injury, including ground-level fall. Two commonly used clinical decision rules (CDRs) to guide C-spine imaging in trauma are the National Emergency X-Radiography Utilization Study (NEXUS) and the Canadian Cervical Spine Rule for Radiography (CCR).
METHODS
Retrospective cross-sectional study of 3,753 consecutive adult patients presenting to an urban Level I emergency department who received C-spine CT scans were obtained over a 6-month period. The primary outcome of interest was prevalence of C-spine fracture. Secondary outcomes included fracture stability, appropriateness of imaging by NEXUS and CCR criteria, and estimated radiation dose exposure and costs associated with C-spine imaging studies.
RESULTS
Of the 760 patients meeting inclusion criteria, 7 C-spine fractures were identified (0.92% ± 0.68%). All fractures were identified by NEXUS and CCR criteria with 100% sensitivity. Of all these imaging studies performed, only 69% met NEXUS indications for imaging (50% met CCR indications). C-spine CT scans in patients not meeting CDR indications were associated with costs of $15,500 to $22,000 by NEXUS ($14,600-$25,600 by CCR) in this single center during the 6-month study period.
CONCLUSION
For ground-level fall, C-spine CT is overused. The consistent application of CDR criteria would reduce annual nationwide imaging costs in the United States by $6.8 to $9.6 million based on NEXUS ($6.4-$15.6 million based on CCR) and would reduce population radiation dose exposure by 0.8 to 1.1 million mGy based on NEXUS (0.7-1.9 million mGy based on CCR) if applied across all Level I trauma centers. Greater use of evidence-based CDRs plays an important role in facilitating emergency department patient management and reducing systemwide radiation dose exposure and imaging expenditures.
LEVEL OF EVIDENCE
Diagnostic study, level III.
背景
对于包括平地跌倒在内的低风险损伤机制，通常会安排颈椎计算机断层扫描（CT）。创伤中指导颈椎成像的两个常用临床决策规则（CDR）是国家急诊X线摄影利用研究（NEXUS）和加拿大颈椎放射摄影规则（CCR）。
方法
对连续6个月内到城市一级急诊科就诊并接受颈椎CT扫描的3753例成年患者进行回顾性横断面研究。主要关注的结果是颈椎骨折的患病率。次要结果包括骨折稳定性、根据NEXUS和CCR标准进行成像的适当性，以及与颈椎成像研究相关的估计辐射剂量暴露和成本。
结果
在符合纳入标准的760例患者中，发现7例颈椎骨折（0.92%±0.68%）。所有骨折均根据NEXUS和CCR标准被识别，灵敏度为100%。在所有进行的这些成像研究中，只有69%符合NEXUS成像指征（50%符合CCR指征）。在这个单一中心为期6个月的研究期间，不符合CDR指征的患者进行颈椎CT扫描的费用，根据NEXUS为15,500美元至22,000美元（根据CCR为1,4600美元至25,600美元）。
结论
对于平地跌倒，颈椎CT被过度使用。如果在所有一级创伤中心应用，根据NEXUS，一致应用CDR标准将使美国每年全国范围内的成像成本降低680万至960万美元（根据CCR为640万至1560万美元），并根据NEXUS使人群辐射剂量暴露减少80万至110万毫戈瑞（根据CCR为70万至190万毫戈瑞）。更多地使用基于证据的CDR在促进急诊科患者管理以及减少全系统辐射剂量暴露和成像支出方面发挥着重要作用。
证据水平
诊断性研究，III级。
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