Cost-effectiveness of Multi-detector Computed Tomography Evaluation of Suspected Acute Blunt Cervical Spine Trauma Patients at Sisaket Hospital

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Anchalee Pipatyaokul


Background: Cervical spine injuries have an increased rate of injury and death in cases of delayed diagnosis. Computer tomography is an appropriate and popular tool for evaluating patients suspected of cervical spine injuries.
Objectives: To study the radiographic characteristics of the cervical spine and to assess the suitability of the cervical spine X-ray examination according to the criteria for evaluating patients at the emergency department at Sisaket Hospital
Study design: Retrospective descriptive study.
Methods: Cervical spine injury patients at the emergency department of Sisaket Hospital from 1st. July 2018 to 31st. January 2019 and undergo a computer scan on the cervical spine without injecting opaque substances. The patients who injured by sharp or shot objects or injured more than three days were excluded in this study. Data was collected from out-patient and in-patient medical records. The data collected were age, sex, important symptoms, causes of injury, indication for the examination of the cervical spine, interpretation record by radiologists. The data were analyzed by using descriptive statistics, reporting as frequency, percentage.
Results: Cervical spine injury patients at the Emergency Department, Sisaket Hospital from 1st July 2018 to 31st January 2019 and undergoing a computerized examination of the cervical spine according to the criteria, a total of 342 cases, 300 patients, 87.7% had an indication of examination according to NEXUS. The most criteria were Alteration of consciousness (44.4%), followed by Midline cervical tenderness (25.1%). There were 42 patients, 12.3% of whom were CT without an indication record. Report found no abnormality, 310 cases (90.6%) and 32 cases had abnormalities (9.4%), age range <18 years, 37 persons found no abnormalities, aged 18-65 years, detected abnormalities 10.6 %, age range> 65 years detected abnormalities 9.8 %. The most abnormal found at the level of lower cervical spine. Patients aged >18 years, 108 cases were study both CT and plain radiograph and 10 were found to have abnormalities from both studies. No abnormalities were detected from plain radiograph alone.
Conclusion: A rigorous assessment of patients with cervical spine injuries using the NEXUS criteria and the selection of radiography in pediatric patients could reduce unnecessary computer tomography.
Keywords: Cervical spine CT, blunt cervical spine trauma, NEXUS.


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1. Griffith B, Bolton C, Goyal N, Brown ML, Jain R. Screening cervical spine CT in a level I trauma center: overutilization? AJR Am J Roentgenol 2011;197(2):463-7.

2. Keats TE, Dalinka MK, Alazraki N, Berquist TH, Daffner RH, DeSmet AA, et al. Cervical spine trauma. American College of Radiology. ACR Appropriateness Criteria. Radiology 2000;215 Suppl:243-6.

3. Sheikh K, Belfi LM, Sharma R, Baad M, Sanelli PC. Evaluation of acute cervical spine imaging based on ACR Appropriateness Criteria®. Emerg Radiol. 2012 Jan;19(1):11-7.

4. Ackland H, Cameron P. Cervical spine - assessment following trauma. Aust Fam Physician 2012;41(4):196-201.

5. Chuthaporn S, Sasitorn P. Multi-detector computed tomography (MDCT) evaluation of suspected acute blunt cervical spine trauma in adult patients at King Chulalongkorn Memorial Hospital. Chula Med J 2016;60(2):143 – 53.

6. Yadollahi M, Paydar S, Ghaem H, Ghorbani M, Mousavi SM, Taheri Akerdi A, et al . Epidemiology of Cervical Spine Fractures. Trauma Mon 2016;21(3):e33608.

8. Munera F, Rivas LA, Nunez DB Jr, Quencer RM. Imaging evaluation of adult spinal injuries: emphasis on multidetector CT in cervical spine trauma. Radiology. 2012 Jun;263(3):645-60.

8. Golob JF Jr, Claridge JA, Yowler CJ, Como JJ, Peerless JR. Isolated cervical spine fractures in the elderly: a deadly injury. J Trauma 2008;64(2):311-5.

9. Fredø HL, Rizvi SA, Lied B, Rønning P, Helseth E. The epidemiology of traumatic cervical spine fractures: a prospective population study from Norway. Scand J Trauma Resusc Emerg Med 2012;20:85.

10. Goldberg W, Mueller C, Panacek E, Tigges S, Hoffman JR, Mower WR, et al. Distribution and patterns of blunt traumatic cervical spine injury. Ann Emerg Med 2001;38(1):17-21.

11. Viccellio P, Simon H, Pressman BD, Shah MN, Mower WR, Hoffman JR, et al. A prospective multicenter study of cervical spine injury in children. Pediatrics 2001;108(2):E20.

12. Hoffman JR, Mower WR, Wolfson AB, Todd KH, Zucker MI. Validity of a set of clinical criteria to rule out injury to the cervical spine in patients with blunt trauma. National Emergency X-Radiography Utilization Study Group. N Engl J Med 2000;343(2):94-9.

13. Stiell IG, Wells GA, Vandemheen KL, Clement CM, Lesiuk H, De Maio VJ, et al. The Canadian C-spine rule for radiography in alert and stable trauma patients. JAMA 2001;286(15):1841-8.

14. Pieretti-Vanmarcke R, Velmahos GC, Nance ML, Islam S, Falcone RA Jr, Wales PW, et al. Clinical clearance of the cervical spine in blunt trauma patients younger than 3 years: a multi-center study of the american association for the surgery of trauma. J Trauma 2009;67(3):543-9; discussion 549-50.

15. Ehrlich PF, Wee C, Drongowski R, Rana AR. Canadian C-spine Rule and the National Emergency X-Radiography Utilization Low-Risk Criteria for C-spine radiography in young trauma patients. J Pediatr Surg 2009;44(5):987-91.

16. Gopinathan NR, Viswanathan VK, Crawford AH. Cervical Spine Evaluation in Pediatric Trauma: A Review and an Update of Current Concepts. Indian J Orthop 2018;52(5):489-500.

17. Rozzelle CJ, Aarabi B, Dhall SS, Gelb DE, Hurlbert RJ, Ryken TC, et al. Management of pediatric cervical spine and spinal cord injuries. Neurosurgery 2013;72 Suppl 2:205-26.

18. Chung S, Mikrogianakis A, Wales PW, Dirks P, Shroff M, Singhal A, et al. Trauma association of Canada Pediatric Subcommittee National Pediatric Cervical Spine Evaluation Pathway: consensus guidelines. J Trauma 2011;70(4):873-84.

19. Jimenez RR, Deguzman MA, Shiran S, Karrellas A, Lorenzo RL. CT versus plain radiographs for evaluation of c-spine injury in young children: do benefits outweigh risks? Pediatr Radiol 2008;38(6):635-44.

20. Sadetzki S, Chetrit A, Lubina A, Stovall M, Novikov I. Risk of thyroid cancer after childhood exposure to ionizing radiation for tinea capitis. J Clin Endocrinol Metab 2006;91(12):4798-804.

21. Ron E. Let's not relive the past: a review of cancer risk after diagnostic or therapeutic irradiation. Pediatr Radiol 2002;32(10):739-44.

22. Jimenez RR, Deguzman MA, Shiran S, Karrellas A, Lorenzo RL. CT versus plain radiographs for evaluation of c-spine injury in young children: do benefits outweigh risks? Pediatr Radiol 2008;38(6):635-44.