Rakosi Robert, Davis Jera, Miller Jordan, Krasner Henry, Batra Kavita, Maitra Sukanta, Fraser Douglas R, McNickle Allison G
Division of Acute Care Surgery, Department of Surgery, Kirk Kerkorian School of Medicine at UNLV, Las Vegas, NV, USA.
Department of Orthopedic Surgery, Kirk Kerkorian School of Medicine at UNLV, Las Vegas, NV, USA.
Am Surg. 2025 Aug;91(8):1341-1347. doi: 10.1177/00031348251337146. Epub 2025 Apr 18.
BackgroundCurrent guidelines from trauma societies recommend cervical spine (c-spine) clearance for obtunded blunt trauma patients after negative CT c-spine (CS-CT). However, the value of additional c-spine MRI (CS-MRI) in patients with low-energy trauma mechanisms is unclear and controversial. This study hypothesizes that obtunded blunt low-energy mechanism trauma patients would not have c-spine injuries requiring surgery on CS-MRI after negative CS-CT.MethodsA retrospective review was conducted at a level 1 trauma center, analyzing adults with low-energy blunt trauma from 2018-2022. Inclusion criteria encompassed individuals over 18 years old admitted to the ICU following assault/fall 10 feet or less requiring intubation for 24+ hours. Exclusion criteria included patients with high-energy trauma or intubated later in their admission/less than 24 hours. Primary outcomes were c-spine injuries identified on MRI following negative CS-CT and percentage of patients requiring surgery. Statistical significance was set at 5%.ResultsOf 1462 charts, 300 patients met inclusion criteria. Of these 300 patients, 194 underwent only CS-CT (64.7%), while 106 underwent both CT and MRI (35.3%). Among the 82 patients with negative CS-CT who received CS-MRI, only 1 (1.2%) was found to have an unstable c-spine injury. Patients who underwent CS-MRI had increased ICU length of stay (7.52 vs 11.87 days) and ventilator days (6.12 vs 9.43 days) compared CS-CT alone.DiscussionThe findings suggest that negative CS-CT is typically sufficient for clearance in low-energy trauma patients. Additional CS-MRI may increase health care resource use without revealing significant injuries, supporting streamlined c-spine clearance protocols based on trauma mechanism.
背景
创伤学会的现行指南建议，对于钝性创伤后意识不清的患者，在颈椎CT（CS-CT）结果为阴性后可排除颈椎损伤。然而，对于低能量创伤机制患者，额外进行颈椎MRI（CS-MRI）检查的价值尚不清楚且存在争议。本研究假设，钝性低能量机制创伤后意识不清的患者在CS-CT结果为阴性后，其颈椎损伤在CS-MRI上不会显示需要手术治疗的情况。
方法
在一家一级创伤中心进行回顾性研究，分析2018年至2022年期间的低能量钝性创伤成年患者。纳入标准包括因10英尺及以下的袭击/跌倒导致入住重症监护病房（ICU）且需要插管24小时以上的18岁以上个体。排除标准包括高能创伤患者或入院后较晚插管/插管时间少于24小时的患者。主要结局指标为CS-CT结果为阴性后MRI上发现的颈椎损伤以及需要手术治疗的患者百分比。设定统计学显著性水平为5%。
结果
在1462份病历中，300例患者符合纳入标准。在这300例患者中，194例仅接受了CS-CT（64.7%），而106例同时接受了CT和MRI检查（35.3%）。在82例CS-CT结果为阴性且接受了CS-MRI检查的患者中，仅1例（1.2%）被发现存在不稳定的颈椎损伤。与仅接受CS-CT检查的患者相比，接受CS-MRI检查的患者在ICU的住院时间更长（7.52天对11.87天），机械通气天数更多（6.12天对9.43天）。
讨论
研究结果表明，对于低能量创伤患者，CS-CT结果为阴性通常足以排除颈椎损伤。额外进行CS-MRI检查可能会增加医疗资源的使用，却未发现严重损伤，这支持了基于创伤机制简化颈椎损伤排除方案。
