Clearing the cervical spine in multiple trauma victims: A time-effective protocol using helical computed tomography

Abstract

This study was performed to evaluate helical computed tomography (HCT) as the primary method of initial cervical spine assessment in multiple trauma victims. Prospective evaluation of the cervical spine using HCT and plain film radiography (PFR) was performed in 800 patients with suspected multisystem injuries. With HCT, an average of 32 slices were obtained at 5-mm intervals from the base of the skull to T1 using helical acquisition and a bone algorithm. HCT was performed following cross-table lateral radiographs of the cervical spine in all patients. We compared HCT and PFR for detection of abnormalities and duration of examination and also compared HCT with conventional CT in a subset of patients (N=20) for image quality/lesion detectability.

Sixty-eight fractures were identified in 46 patients. HCT prospectively identified 67 fractures (98.5%), and plain films demonstrated 29 fractures (43%). No difference in image quality/lesion detectability was encountered when comparing HCT to conventional CT. HCT of the cervical spine could be completed in 4.5 minutes and added an average of only 8 minutes to the stay of the patient in the CT room. During the time of the study, the overall patient disposition time from the trauma resuscitation area was reduced from 6.5 to 4.5 hours. Rapid and accurate evaluation of the cervical spine is possible with HCT and is recommended as part of the initial imaging protocol in multiple trauma patients.