Haas Brian M, Hahn Lewis D, Oliva Isabel
Department of Radiology and Biomedical Imaging, University of California, San Francisco, 1001 Potrero Ave, Room 1X57, SFGH, Box 1325, San Francisco, CA, 94110, USA.
Department of Radiology, Stanford University, 300 Pasteur Dr, Stanford, CA, 94305, USA.
Emerg Radiol. 2019 Apr;26(2):133-138. doi: 10.1007/s10140-018-1652-5. Epub 2018 Nov 1.
Plain radiography of the cervical spine is used as a screening test for trauma patients. We evaluated the diagnostic yield of performing anteroposterior (AP), odontoid, and oblique views in addition to the lateral view in the current era when radiographs are performed only on low-risk patients.
All imaging reports from cervical spine radiography studies on patients aged 18 years and older in the emergency room of a major academic medical center between November 22, 2003, and January 17, 2012, were retrospectively reviewed. For the clinical workflow employed at the time of study acquisition, radiologists prospectively reviewed the lateral projection and subsequently reviewed the entirety of the images obtained. Exam reports and, when necessary, images were reviewed to determine which patients had fractures and on which projection the fractures were identified.
Six fractures were detected in 7218 exams. Three of these fractures were identified on the lateral radiograph, and three of these fractures were visualized on the additional projections (two on oblique and one on odontoid views). The yield of the additional projections is one fracture per 9713 radiographic projections (90% confidence interval of one fracture per 1245-47,946 examinations). For two of the patients with fractures identified on the lateral projection, an additional fracture was seen when CT was then performed.
Performing additional radiographs of the cervical spine including AP, odontoid, and bilateral oblique projections in trauma patients with low pretest probability of fracture augments the diagnostic yield of lateral radiographs. Considering the potential for devastating neurological outcomes from missed cervical fractures, addition of AP, odontoid, and oblique projections continues to detect fractures at a low rate.
颈椎X线平片用作创伤患者的筛查检查。在当前仅对低风险患者进行X线检查的时代，我们评估了除侧位片外，加做前后位（AP）、齿突位和斜位片的诊断价值。
回顾性分析了2003年11月22日至2012年1月17日期间，一家大型学术医疗中心急诊科对18岁及以上患者进行的颈椎X线检查的所有影像报告。对于研究采集时采用的临床工作流程，放射科医生先前瞻性地查看侧位片，随后查看全部获取的影像。查阅检查报告，并在必要时查看影像，以确定哪些患者发生了骨折以及在哪个投照位上发现了骨折。
在7218次检查中发现了6处骨折。其中3处骨折在侧位X线片上被发现，另外3处骨折在额外的投照位上显影（2处在斜位片，1处在齿突位片）。额外投照位的检出率为每9713次X线投照发现1处骨折（90%置信区间为每1245 - 47946次检查发现1处骨折）。对于在侧位片上发现骨折的2例患者，在随后进行CT检查时又发现了1处额外骨折。
对于骨折预检概率低的创伤患者，加做包括AP位、齿突位和双侧斜位投照的颈椎X线片可提高侧位片的诊断价值。考虑到漏诊颈椎骨折可能导致严重的神经功能后果，加做AP位、齿突位和斜位投照仍能以较低的比率发现骨折。
