Computed tomography versus magnetic resonance imaging of the cervical spine in the spinal clearance of trauma patients: a systematic review and meta-analyses.

PURPOSE

(1) Assess the proportion of trauma patients with missed cervical spine injuries that magnetic resonance imaging (MRI) identifies after a negative computed tomography (CT); (2) Perform subgroup analyses based on age and Glasgow Coma Scale (GCS) on presentation; (3) Evaluate treatment changes due to MRI findings.

METHODS

This systematic review and meta-analyses was conducted with reference to the PRISMA guidelines. We included studies investigating cervical spine clearance in trauma patients using CT and MRI. Outcomes of interest included the number of injuries each modality identified, and the number of treatment changes prompted by MRI findings. Outcomes were expressed as proportions and their 95% confidence intervals (95% CI). This study is registered with PROSPERO at CRD42023490354.

RESULTS

Thirty-six studies involving 6784 patients were analysed. MRI identified missed injuries in 17% of patients following a negative CT (Proportions 0.17, 95% CI 0.12-0.23). Subgroup analyses showed that paediatrics (Proportions 0.32, 95% CI 0.13-0.58) were at higher risk of missed injuries than adults (Proportions 0.13, 95% CI 0.05-0.27), and that alert patients (Proportions 0.28, 95% CI 0.13-0.48) were at higher risk of missed injuries than obtunded patients (Proportions 0.14, 95% CI 0.08-0.23). Clinically significant injuries identified on MRI prompted treatment changes in 4% of patients (Proportions 0.04, 95% CI 0.02-0.07).

CONCLUSION

Trauma patients with a negative CT cervical spine had a 17% chance of missed injuries if MRI cervical spine was not performed, with paediatric and alert patients having a higher risk. These missed injuries can lead to potential morbidity and mortality if left untreated.