| Frequent computed tomography scanning due to incomplete three-view X-ray imaging of the cervical spine. | |
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MedLine Citation:
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PMID: 20016389 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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BACKGROUND: Conventional C-spine imaging (3-view series) is still widely used in trauma patients, although the utilization of computed tomography (CT) scanning is increasing. The aim of this study was to analyze the value of conventional radiography and the frequency of subsequent CT scanning due to incompleteness of three-view series of the C-spine in adult blunt trauma patients. METHODS: We analyzed the data of a prospectively collected database including all patients between November 2005 and November 2007 treated in the trauma resuscitating room. We assessed the reasons for subsequent CT scanning after the three-view series according to the following classification: inevaluability, incompletion, evaluation of findings on three-view series or evaluation of unexplained, and persistent clinical symptoms. Furthermore, we evaluated possible predictors for incompleteness. RESULTS: Of 1,283 blunt trauma patients, 88 C-spine injuries were diagnosed with an overall incidence of 6.9%. One hundred fifty-nine patients (12%) had their C-spine cleared based on the NEXUS criteria and 12 died before C-spine imaging could be performed. A total of 717 patients were primarily evaluated with three-view series and 395 patients primarily with CT scanning. Within the population with primarily three-view series, 249 (35%) were repeatedly incomplete and 16 (2%) were inevaluable. In the majority of the incomplete three-view series, no apparent reason could be determined. However, the presence of clavicular fractures (resulting in incomplete radiographs in 68% vs. 34% without a fracture; p < 0.001) and rib fractures (56% vs. 34%; p = 0.008) were associated with incomplete three-view series. CONCLUSION: In more than one third of the patients primarily assessed with three-view X-ray series of the C-spine, the results are incomplete or inevaluable necessitating CT scanning. Although the majority of the incomplete series remain unexplained, we advise CT scanning in patients having clavicular and rib fractures because this increases the likelihood of obtaining incomplete three-view series. |
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Authors:
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Teun Peter Saltzherr; Ludo F M Beenen; Johannes B Reitsma; Jan S K Luitse; W Peter Vandertop; J Carel Goslings |
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Publication Detail:
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Type: Journal Article |
Journal Detail:
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Title: The Journal of trauma Volume: 68 ISSN: 1529-8809 ISO Abbreviation: J Trauma Publication Date: 2010 May |
Date Detail:
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Created Date: 2010-05-10 Completed Date: 2010-05-27 Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 0376373 Medline TA: J Trauma Country: United States |
Other Details:
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Languages: eng Pagination: 1213-7 Citation Subset: AIM; IM |
Affiliation:
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Trauma Unit Department of Surgery, Neurosurgical Center Amsterdam, Amsterdam, The Netherlands. t.p.saltzherr@amc.uva.nl |
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| MeSH Terms | |
Descriptor/Qualifier:
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Adult Analysis of Variance Artifacts Cervical Vertebrae* / injuries, radiography Clavicle / injuries Clinical Protocols Diagnostic Errors / statistics & numerical data Female Humans Male Middle Aged Multiple Trauma / radiography Netherlands / epidemiology Patient Selection Physician's Practice Patterns Posture Prospective Studies Rib Fractures / radiography Spinal Fractures / radiography Spinal Injuries / epidemiology, radiography Tomography, X-Ray Computed / methods*, utilization Trauma Centers Unnecessary Procedures / statistics & numerical data Wounds, Nonpenetrating / radiography |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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