Thurs., 10/16/08 Spine, Paper #3, 2:42 pm OTA-2008
Trauma CT Scanning of the Abdomen and Pelvis Is a Reliable Screening Tool for Significant Thoracolumbar Injury Resulting from Blunt Trauma
Micah Smith, MD1 (n); John D. Reed, MD2 (n); Raymond Facco, MD, FACS2 (n);
Thein Hlaing, MBBS, FACE3 (n); Mary Aaland, MD, FACS3 (n); B. Matthew Hicks, MD4 (n);
1Fort Wayne Medical Education Program, Fort Wayne, Indiana, USA;
2Fort Wayne Radiology, Fort Wayne, Indiana, USA;
3Parkview Hospital Trauma Services, Fort Wayne, Indiana, USA;
4Fort Wayne Orthopaedics, Fort Wayne, Indiana, USA
Purpose: Recent literature suggests that CT chest/abdomen/pelvis (TS) diagnoses thoracolumber spine (TLS) fractures more accurately than radiographic TLS (XR). The hypothesis of our study is to validate that nonreconstructed trauma CT scan is a reliable screening tool for TLS injuries in blunt trauma patients with altered mental status.
Methods: The design was a prospective cohort study consisting of 75 consecutive patients admitted to a verified Level 2 trauma center presenting with altered mental status. Each patient had a trauma CT abdomen/pelvis (A/P) per trauma scan protocol of 5-mm slices and AP/lateral XR of the thoracic and lumbar spine. Reconstructed CT of the spine was competed at 2-mm slices; trauma chest CT was done when indicated. Sensitivity and specificity and their 95% confidence intervals (CI) were calculated for thoracic and lumbar spine injuries.
Results: The study patients were victims of motor vehicle crash (n = 58), fall (9), pedestrian struck (5), and blunt assault (3). The patients were intubated (29), inebriated (21), confused or repetitive (29), and obtunded/seizure (2) at the time of admission. TLS fractures detected were as follows: reconstruction CT of the spine (72), CT A/P (58), and chest CT (16). Employing reconstructions as the standard, TS had a sensitivity of 89% (95% CI 65-96) and specificity of 85% (65-96) for all fractures detected. Sensitivity and specificity were 100% for the presence of a fracture in a patient. Overall, the TS missed eight transverse process fractures, and one superior endplate fracture (OTA 53A1.1); lumbar spine XR missed one Chance fracture (OTA 52-B2.1), among others. No fractures missed by the TS required surgery or other interventions.
Conclusions: The TS diagnosed fractures of the TLS more accurately than XR. Only minor fractures were missed by the TS, suggesting that in the acute trauma setting, reconstructions do not need to be ordered unless something is found on the TS that needs further elucidation. We have thus validated the reliability of TS as a screening tool in detecting TLS injuries in mentally altered blunt trauma patients.
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.
• The FDA has not cleared this drug and/or medical device for the use described in this presentation (i.e., the drug or medical device is being discussed for an “off label” use). ◆FDA information not available at time of printing. Δ OTA Grant