II. Indications: Acute Trauma
- Decision rules for Cervical Spine imaging in general
- Absolute indications for CT C-Spine over Cervical Spine XRay (C-Spine Injury probability >5%)
- High risk mechanism of injury
- High-speed MVA with combined impact >35 mph (or 56 kph)
- MVA with death at scene
- Fall from height >10 feet (or 3 meters)
- High risk clinical findings
- Significant Closed Head Injury or Intracranial Hemorrhage on Head imaging
- Neurologic symptoms or signs referred from the Cervical Spine
- Multiple extremity Fractures
- Pelvic Fracture
- References
- High risk mechanism of injury
- Other indications for CT C-Spine over XRay
- In most Trauma cases Cervical Spine imaging is performed with CT
- Alternatives such as Cervical Spine XRay is often inadequate with up to 20-40% False Negative Rate
- C7 difficult visualization (e.g. obese or muscular patients)
- Abnormal cervical anatomy such as Rheumatoid Arthritis or Osteoarthritis in elderly (especially C1 and C2 injuries)
- In most Trauma cases Cervical Spine imaging is performed with CT
III. Adverse Effects
- See CT-associated Radiation Exposure
- Concentrated radiation to skin of neck and Thyroid Gland
IV. Efficacy: Acute Traumatic Injury
- Test Sensitivity for Fracture: 98%
- CT Cervical Spine alone with axial slices <3mm has 100% NPV for unstable Cervical Spine Injury
- May someday obviate need for C-Collar or MRI in obtunded patients (follow local guidelines)
- Patel (2015) J Trauma Acute Care Surg 78(2): 430-41 [PubMed]
V. References
- Jang and Kaji (2013) Crit Dec Emerg Med 27(6): 2-9
- Bagley (2006) Radiol Clin North Am 44(1): 1-12 [PubMed]
- Holmes (2005) J Trauma 58(5): 902-5 [PubMed]
- Bailitz (2009) J Trauma 66(6): 1605-9 [PubMed]