A new national study indicates that patients with a cervical spinalinjury (CSI) may harbor additional spinal damage not visible on regularx-rays. In fact, more than a third of patients who were thought to havelow-risk injuries actually have additional damage that may includesignificant fractures with the potential to produce serious spinalproblems if not detected and treated properly.
This study will be published as an early online release in theAnnals of Emergency Medicine, stands in the face of previous medicalthinking in which patients with certain forms of spinal injury wereconsidered at very low risk of having additional injuries. Because ofthat low risk, physicians were urged to use plain x-rays and avoidcomputed tomography (CT) in evaluating these cases.
"These findings are significant because they suggest that CTimaging, which allows physicians to view the spine in much greaterdetail, is necessary in evaluating all patients who have radiographicevidence of cervical spine injuries," said lead study author Dr.William Mower, professor of emergency medicine at the David GeffenSchool of Medicine at UCLA. "We found that even among patients withlow-risk injuries, more than one third sustained secondary damage thatwas not diagnosed by plain radiography."
Mower adds that approximately one-fourth of these secondaryinjuries occurred in another part of the cervical spine, which suggeststhat at least some of these patients may have actually sustained twoseparate spinal injuries.
Researchers reviewed patient cases from the National EmergencyX-Radiography Utilization Study (NEXUS), which was conducted at 21centers across the United States.
Study authors found that x-rays failed to detect secondaryinjuries in 81 of the 224 patients identified with cervical spineinjuries � or 36 percent. "We also think that this is likely anunderestimate, and the true prevalence of missed injury is probablyeven greater," said Mower.
The researchers believe that patients with any evidence ofcervical spine injury, including those with cervical spine injuriespreviously considered to be at low risk for secondary injuries, shouldundergo CT imaging of the entire cervical spine. CT should be obtainedboth to determine whether secondary injuries are present and toidentify those non-contiguous injuries that, in fact, occur in asubstantial number of cases.
The study was funded by theAgency for Healthcare Research and Policy, part of the United StatesDepartment of Health and Human Services
The article will be available online September 7 at http://www.mosby.com/annemergmed
Other authors include: Dr. Tyler W. Barrett and Dr. Jerome R.Hoffman, UCLA Emergency Medicine Center; Dr. Michael I. Zucker,Department of Radiology, UCLA Medical Center.
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