ADEQUACY AND EFFICACY OF LATERAL CERVICAL-SPINE RADIOGRAPHY IN ALERT,HIGH-RISK BLUNT TRAUMA PATIENT

Objective: The purpose of this study was to determine the adequacy and accuracy of lateral cervical spine radiographs in the initial evaluat ion of alert, high-risk trauma patients evaluated at a Level I trauma center, Methods: Data were obtained retrospectively through review of trauma service admissions from January 1, 1994, to July 31, 1995, Incl uded were all patients triaged to a trauma response team with age > 15 years, Glasgow Coma Scale store > 13, and blunt mechanism of injury, Lateral cervical spine radiograms were obtained routinely before secon dary survey and were reviewed for technical adequacy (all seven cervic al vertebrae, C7/T1 interspace). The presence of cervical symptoms (pa in, tenderness, neurologic deficits) was recorded, Sensitivity and spe cificity were calculated for lateral cervical spine radiograph and cer vical symptoms in predicting the presence of cervical spine injury, Ba yesian analysis, which allows for the current probability of occurrenc e to be factored by previously reported probabilities of occurrence, w as used to determine the negative predictive probability of lateral ce rvical spine radiography and absence of cervical symptoms to predict t he absence of injury to the cervical spine, Results: Three hundred fif ty-three patients received Intel al cervical spine radiograms, of whic h 223 (63%) were determined to be adequate for interpretation, Cervica l symptoms were present in 77 patients (20%), Only 32 (42%) of this gr oup's lateral cervical spine radiograms were adequate. Nine patients ( 2.4%) had acutely fractured cervical vertebrae or ligamentous disrupti on, Lateral cervical spine radiography shelved the injury in only six of these patients, Tile sensitivity, specificity, and negative predict ive probability for lateral cervical spine radiograph were 67, 58, and 1.4%, respectively, and for absence of cervical symptoms, 89, SI, and 0.32%, respectively. Conclusion: The higher accuracy and lower negati ve predictive probability make the absence of cervical symptoms in the alert, high-risk, blunt trauma patient a better screening test than l ateral cervical spine radiography. We suggest that lateral cervical sp ine radiography is not needed in the initial evaluation of alert patie nts who have sustained blunt trauma.