Prospective evaluation of multislice computed tomography versus plain radiographic cervical spine clearance in trauma patients

J Trauma. 2007 Jun;62(6):1427-31. doi: 10.1097/01.ta.0000239813.78603.15.


Background: The objective of this study was to compare the utility of plain radiographs to multislice computed tomography (MCT) for cervical spine (c-spine) evaluation. We hypothesized that plain radiographs add no clinically relevant diagnostic information to MCT in the screening evaluation of the c-spine of trauma patients.

Methods: This was a prospective, unblinded, consecutive series of injured patients requiring c-spine evaluation that were imaged with three-view plain films and MCT (occiput to T1 with 3-dimensional reconstruction). The final discharge diagnosis based on all prospectively collected clinical data, MCT, and plain films was utilized as the gold standard for the sensitivity calculation.

Results: From October 2004 to February 2005, 667 trauma patients requiring c-spine evaluation were enrolled. Average age was 35.4 years and 70% were male. The mechanism of injury was blunt in 99% and 48.7% occurred as a result of motor vehicle collision. Sixty of 667 (9%) sustained acute c-spine injuries. MCT had a sensitivity of 100% and specificity of 99.5%. Plain films had a sensitivity of 45% and specificity of 97.4%. Plain radiography missed 15 of 27 (55.5%) clinically significant c-spine injuries.

Conclusion: MCT outperformed plain radiography as a screening modality for the identification of acute c-spine injury in trauma patients. All clinically significant injuries were detected by MCT. Plain films failed to identify 55.5% of clinically significant fractures identified by MCT and added no clinically relevant information.

Publication types

  • Comparative Study

MeSH terms

  • Adult
  • Algorithms
  • Cervical Vertebrae / diagnostic imaging*
  • Cervical Vertebrae / injuries*
  • Female
  • Humans
  • Joint Dislocations / diagnostic imaging
  • Ligaments / diagnostic imaging
  • Ligaments / injuries
  • Male
  • Mass Screening
  • Prospective Studies
  • Spinal Fractures / diagnostic imaging*
  • Tomography, X-Ray Computed*
  • Wounds and Injuries / complications