R. Rakosi1, L. Davis2, K. Batra1, H. Krasner1, J. Miller2, S. Maitra2, D. Fraser1, A. McNickle1 1University Of Nevada Las Vegas School Of Medicine, Trauma/Acute Care Surgery, Las Vegas, NV, USA 2University of Nevada Las Vegas School of Medicine, Orthopedics, Las Vegas, NV, USA
Introduction:
There is limited data analyzing low-energy mechanisms and cervical spine clearance in the obtunded blunt trauma patient population. Current guidelines from multiple trauma societies recommend cervical spine clearance when high-quality CT C-spine imaging is performed and negative in this population. We hypothesize that additional MRI imaging in low-energy trauma mechanism trauma patients in the setting of negative CT C-spine imaging will reveal no additional injury findings requiring surgical intervention and unnecessarily increase healthcare utilization costs.
Methods:
A retrospective review at a level 1 trauma center of adults with low-energy blunt trauma from 2018-2022 was conducted. Of 1438 screened charts, 302 met inclusion criteria of age ≥ 18 years, intubated for over 24 hours, and incurred mechanism of assault or ground-level fall. Primary outcomes included frequency of c-spine injuries identified on MRI after negative CT imaging and the percentage of patients requiring surgery. Secondary outcomes included complications of cervical collar use, ICU LOS, and ventilator days. Univariate and bivariate methods were used and significance level was set at 5%
Results:
302 patients were reviewed with 194 patients undergoing only CT C-spine and 108 102 patients undergoing both CT and MRI C-spine imaging. Between both groups, there was no significant difference in complications to cervical collar use (2 vs 2, p = 0.5). Of the 108 patients in the latter group, 84 patients had negative CT C-spine imaging that ended up undergoing further MRI screening. Of these 84 patients, only 3 (3.6%) were found to have an unstable c-spine injury. There was an increase in ICU LOS (7.52 vs 11.43 days) and ventilator days (6.12 vs 9.22 days) with patients with negative C-spine imaging who underwent MRI compared to CT C-spine imaging only.
Conclusion:
This study shows that negative CT C-spine imaging is sufficient in C-spine clearance in most low-mechanism obtunded blunt trauma patients. Furthermore, additional MRI imaging is associated with higher healthcare resource utilization without identification of significant injury in the large majority of patients. Using this data can help reinforce C-spine clearance algorithms based on mechanism to decrease unnecessary healthcare resource utilization without impacting patient outcomes.
