Zabel D D, Tinkoff G, Wittenborn W, Ballard K, Fulda G
Department of Surgery, Medical Center of Delaware, Wilmington, USA.
J Trauma. 1997 Dec;43(6):952-6; discussion 957-8. doi: 10.1097/00005373-199712000-00015.
The purpose of this study was to determine the adequacy and accuracy of lateral cervical spine radiographs in the initial evaluation of alert, high-risk trauma patients evaluated at a Level I trauma center.
Data were obtained retrospectively through review of trauma service admissions from January 1, 1994, to July 31, 1995. Included were all patients triaged to a trauma response team with age > 15 years, Glasgow Coma Scale score > 13, and blunt mechanism of injury. Lateral cervical spine radiograms were obtained routinely before secondary survey and were reviewed for technical adequacy (all seven cervical vertebrae, C7/T1 interspace). The presence of cervical symptoms (pain, tenderness, neurologic deficits) was recorded. Sensitivity and specificity were calculated for lateral cervical spine radiography and cervical symptoms in predicting the presence of cervical spine injury. Bayesian analysis, which allows for the current probability of occurrence to be factored by previously reported probabilities of occurrence, was used to determine the negative predictive probability of lateral cervical spine radiography and absence of cervical symptoms to predict the absence of injury to the cervical spine.
Three hundred fifty-three patients received lateral cervical spine radiograms, of which 223 (63%) were determined to be adequate for interpretation. Cervical symptoms were present in 77 patients (20%). Only 32 (42%) of this group's lateral cervical spine radiograms were adequate. Nine patients (2.4%) had acutely fractured cervical vertebrae or ligamentous disruption. Lateral cervical spine radiography showed the injury in only six of these patients. The sensitivity, specificity, and negative predictive probability for lateral cervical spine radiography were 67, 58, and 1.4%, respectively, and for absence of cervical symptoms, 89, 81, and 0.32%, respectively.
The higher accuracy and lower negative predictive probability make the absence of cervical symptoms in the alert, high-risk, blunt trauma patient a better screening test than lateral cervical spine radiography. We suggest that lateral cervical spine radiography is not needed in the initial evaluation of alert patients who have sustained blunt trauma.
本研究旨在确定在一级创伤中心对警觉的高危创伤患者进行初始评估时，颈椎侧位X线片的充分性和准确性。
通过回顾1994年1月1日至1995年7月31日创伤服务入院患者的数据进行回顾性研究。纳入所有被分诊到创伤反应小组的年龄>15岁、格拉斯哥昏迷量表评分>13且为钝性损伤机制的患者。颈椎侧位X线片在二次检查前常规获取，并检查其技术充分性（所有七个颈椎、C7/T1间隙）。记录颈部症状（疼痛、压痛、神经功能缺损）的存在情况。计算颈椎侧位X线片和颈部症状在预测颈椎损伤存在方面的敏感性和特异性。采用贝叶斯分析，该分析允许根据先前报道的发生概率对当前发生概率进行因素分析，以确定颈椎侧位X线片和无颈部症状对预测颈椎无损伤的阴性预测概率。
353例患者接受了颈椎侧位X线片检查，其中223例（63%）被确定为适合解读。77例患者（20%）存在颈部症状。该组中只有32例（42%）的颈椎侧位X线片适合解读。9例患者（2.4%）有颈椎急性骨折或韧带断裂。颈椎侧位X线片仅显示其中6例患者的损伤。颈椎侧位X线片的敏感性、特异性和阴性预测概率分别为67%、58%和1.4%，无颈部症状时分别为89%、81%和0.32%。
更高的准确性和更低的阴性预测概率使得警觉的高危钝性创伤患者无颈部症状比颈椎侧位X线片是更好的筛查试验。我们建议，在对遭受钝性创伤的警觉患者进行初始评估时不需要颈椎侧位X线片检查。
