Session VII - Spine

Fri., 10/21/05 Spine, Paper #28, 3:00 pm

A Prospective Comparison of Helical CT Alone versus Plain Films with Adjunct CT for Radiographic Evaluation of the Cervical Spine in Trauma Patients

Patrick T. McCulloch, MD (a-Jon Michael Moore Trauma Center,
West Virginia University Grant); John C. France, MD (n);
Dina L. Jones, PhD (n); W. Krantz (n); T. Nguyen (n); C. Chambers (n);
Joe Dorchak (n); P. Mucha (n);
West Virginia University, Morgantown, West Virginia, USA

Purpose: The purpose of this study was to determine if helical CT alone can be used in trauma patients to evaluate the cervical spine for acute bony injury, thus eliminating the need to obtain plain films.

Methods: Patients prospectively underwent helical CT scanning of the cervical spine and standard, 3-view plain radiography. At a later date, the plain films and CT were independently read by two radiologists who were blinded to both the initial reading and the corresponding study reading. The radiologists documented whether the plain films were adequate, and whether or not an acute process was identified. The study readings were compared with the initial readings and discharge summaries to determine if an injury had been identified. The accuracy of plain films, adequate plain films, and helical CT when used alone were ascertained.

Results: Plain films and helical CTs were obtained in 407 patients. Traumatic injuries were identified in 58 patients (14%). Plain films alone were adequate in 194 patients (48%). Plain films were 45% sensitive and 97% specific, with a positive predictive value (PPV) of 74% and a negative predictive value (NPV) of 91%. Adequate plain films were 52% sensitive and 98% specific with a PPV and NPV of 81% and 93%, respectively. Helical CT was 98% sensitive and specific with a PPV of 89% and a NPV of >99%. There were significant differences in the sensitivity, PPV, and NPV (P<0.001) of adequate plain films compared to helical CT alone. Of 194 patients with adequate plain films, 12 of 25 (48%) missed an injury that was identified on CT. Helical CT alone missed one injury (1.7%).

Conclusions: Helical CT can be safely used without plain films to radiographically evaluate the cervical spine of trauma patients.

Significance: If a helical CT is obtained in a trauma patient, plain films do not need to be obtained as well. This will save time, eliminate extra radiation, and save further cost.

If noted, the author indicates something of value received. The codes are identified as a-research or institutional support; b-miscellaneous funding; c-royalties; d-stock options; e-consultant or employee; n-no conflicts disclosed, and *disclosure not available at time of printing.