Saint Louis University School of Medicine, Saint Louis, MO, USA.
Departments of Trauma and Neurosurgery, Saint Louis University, Saint Louis, MO, USA.
BMC Emerg Med. 2022 Jun 11;22(1):106. doi: 10.1186/s12873-022-00657-x.
Clinically occult cervical spine (CS) injuries are well described in blunt trauma, however delay in identifying these injuries and clearing the CS can result in morbidity. Our study examines the ground level fall (GLF) population to analyze whether computed tomography (CT) alone can rule out unstable injury in this group with lower force mechanism.
This is a single center, retrospective cohort study. All GLF patients in the institutional trauma registry between 6/1/2012 through 12/31/2019 were included. These comprise all trauma patients evaluated in the emergency department with Injury Severity Score (ISS) > 0, including both activations and consults with both clinical and radiological spine evaluation. Patients who could not be cleared by National Emergency X-ray Utilization Study (NEXUS) criteria underwent CT. Patients with CT or clinical suspicion of cord or ligamentous injury underwent MRI. CT occult injuries were identified by MRI and clinical exam, with MRI identifying all unstable injuries.
Sixty-nine (2.0%) of patients had CS injury without acute CT abnormality. Of these, 11 (0.3%) required surgery and were considered unstable. All patients who required surgery had a neurologic deficit. Negative predictive value (NPV) of CT for unstable CS injury was 99.7%. The combination of acute CT findings and neurologic deficit ruled out unstable CS injury with 100% NPV.
In the GLF population, CT alone rules out unstable CS injury with high, but not perfect NPV. The combination of absence of acute CT findings and acute neurologic deficits rules out unstable CS injury with 100% NPV.
在钝性创伤中，临床上隐匿性颈椎（CS）损伤已有详细描述，然而，延迟识别这些损伤并清除 CS 可能会导致发病率增加。我们的研究检查了地面水平坠落（GLF）人群，以分析在这种低力机制下，单独使用计算机断层扫描（CT）是否可以排除不稳定损伤。
这是一项单中心回顾性队列研究。机构创伤登记处 2012 年 6 月 1 日至 2019 年 12 月 31 日期间所有 GLF 患者均纳入本研究。这些患者包括急诊科评估的所有创伤患者，损伤严重程度评分（ISS）>0，包括临床和放射学脊柱评估的激活和咨询。无法通过国家急诊 X 射线利用研究（NEXUS）标准排除的患者行 CT 检查。有 CT 或临床怀疑脊髓或韧带损伤的患者行 MRI 检查。MRI 识别 CT 隐匿性损伤，并识别所有不稳定损伤。
69 例（2.0%）患者 CS 损伤无急性 CT 异常。其中 11 例（0.3%）需要手术，被认为不稳定。所有需要手术的患者均有神经功能缺损。CT 对不稳定 CS 损伤的阴性预测值（NPV）为 99.7%。急性 CT 表现和神经功能缺损的组合可排除不稳定 CS 损伤，NPV 为 100%。
在 GLF 人群中，单独使用 CT 可排除不稳定 CS 损伤，其 NPV 较高，但并非完美。急性 CT 无异常表现和急性神经功能缺损的组合可排除不稳定 CS 损伤，NPV 为 100%。
