Collar Preferable to Imaging in Unevaluable Trauma Patients

Neuroimaging tests lack sensitivity for cervical spine evaluation, not cost-effective versus collar
By Monica Smith
HealthDay Reporter

FRIDAY, Aug. 27 (HealthDay News) -- Imaging tests used for cervical spine clearance in unevaluable trauma patients lack sensitivity and are not cost-effective compared with empirical immobilization by a semi-rigid collar, according to research published in the Aug. 15 issue of Spine.

Casey H. Halpern, M.D., of the University of Pennsylvania Medical Center in Philadelphia, and colleagues reviewed literature on cervical spine trauma, radiographic clearance techniques, and complications associated with the use of semi-rigid collars. Their objective was to compare the results of different management strategies for trauma patients with a clinically unevaluable cervical spine because of impaired consciousness, painful distracting injuries, or endotracheal intubation.

The researchers found that just more than 7.5 percent of unevaluable patients have injuries to the cervical spine, 42 percent of which are associated with spinal instability. Sensitivities for plain radiography or fluoroscopy, computed tomography, and magnetic resonance imaging for spinal clearance were 57, 83, and 87 percent, respectively. Complications related to collar use were generally minor and short-lived. The impact of quadriplegia resulting from spinal instability not detected by a clearance test had substantial impacts on quality of life, longevity, and costs, and these impacts overshadowed the effects of prolonged collar application. Therefore, the researchers concluded that neuroimaging studies for spine clearance in unevaluable patients are not cost-effective when compared with collar immobilization.

"Tests commonly used to clear the spine lack sufficient sensitivity to compete with empirical application of a semi-rigid collar until normal responsiveness is regained. Even a theoretical test or combination of tests with perfect sensitivity is unlikely to be cost-effective compared with a collar," the authors write.

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