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Can emergency physicians accurately rule out clinically important cervical spine injuries by using computed tomography?

Published online by Cambridge University Press:  04 March 2015

Hendrik P. Van Zyl ,
James Bilbey ,
Alan Vukusic ,
Todd Ring ,
Jennifer Oakes ,
Lykke D. Williamson  and
Ian V. Mitchell
Hendrik P. Van Zyl*
Affiliation:
Emergency Department, Royal Inland Hospital, Kamloops, BC
James Bilbey
Affiliation:
Diagnostic Imaging Department, the Royal Inland Hospital, Kamloops, BC
Alan Vukusic
Affiliation:
Emergency Department, Royal Inland Hospital, Kamloops, BC
Todd Ring
Affiliation:
Emergency Department, Royal Inland Hospital, Kamloops, BC
Jennifer Oakes
Affiliation:
Emergency Department, Royal Inland Hospital, Kamloops, BC
Lykke D. Williamson
Affiliation:
Emergency Department, Royal Inland Hospital, Kamloops, BC
Ian V. Mitchell
Affiliation:
Emergency Department, Royal Inland Hospital, Kamloops, BC
*
Emergency Department, Royal Inland Hospital, 311 Columbia Street, Kamloops, BC V2C 2T1; [email protected]

Abstract

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Objective:

Emergency physicians are expected to rule out clinically important cervical spine injuries using clinical skills and imaging. Our objective was to determine whether emergency physicians could accurately rule out clinically important cervical spine injuries using computed tomographic (CT) imaging of the cervical spine.

Method:

Fifteen emergency physicians were enrolled to interpret a sample of 50 cervical spine CT scans in a nonclinical setting. The sample contained a 30% incidence of cervical spine injury. After a 2-hour review session, the participants interpreted the CT scans and categorized them into either a suspected cervical spine injury or no cervical spine injury. Participants were asked to specify the location and type of injury. The gold standard interpretation was the combined opinion of two staff radiologists.

Results:

Emergency physicians correctly identified 182 of the 210 abnormal cases with cervical spine injury. The sensitivity of emergency physicians was 87% (95% confidence interval [CI] 82–91), and the specificity was 76% (95% CI 74–77). The negative likelihood ratio was 0.18 (95% CI 0.12–0.25).

Conclusion:

Experienced emergency physicians successfully identified a large proportion of cervical spine injuries on CT; however, they were not sufficiently sensitive to accurately exclude clinically important injuries. Emergency physicians should rely on a radiologist review of cervical spine CT scans prior to discontinuing cervical spine precautions.

Keywords

cervical spine injurycomputed tomographyemergency physiciansensitivitytrauma
Type
Original Research • Recherche originale
Information
Canadian Journal of Emergency Medicine , Volume 16 , Issue 2 , March 2014 , pp. 131 - 135
Copyright
Copyright © Canadian Association of Emergency Physicians 2014

References

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