Clinical exam and CT scan recommended…

In the trauma center, a common approach to diagnosing cervical spine injury is the clinical exam and, if needed, an additional plain radiograph. However, plain radiologic screening has a high false negative rate (the chance of missing an actual injury). The CT scan has been considered a much more sensitive tool for the diagnosis of cervical spine injury.

Researchers from the Department of Surgery at the University of South Alabama evaluated 1,687 trauma patients to determine how sensitive and useful the CT scan could be in the diagnosis of cervical spine injury. Of these trauma patients, 139 patients were diagnosed with a cervical spine injury.

The researchers also addressed the problem of distracting injury during the clinical exam. Distracting injuries are organ injuries, dislocations, or fractures other than the cervical spine-all of which could create pain that distracts from an accurate diagnosis.

Their results found that the clinical exam alone was able to accurately clear a patient without cervical spine injury. In the presence of symptomatic pain, however, the combination of traditional clinical exam and a CT scan was a sensitive and useful method for diagnosing cervical spine patients with a Glasgow Coma Scale of over 14 (alert and awake). Patients with a Glasgow Coma Scale of less than 14 (altered mental state) were best screened using the CT scan. Distracting injuries did not have a significant impact on the reliability of the clinical exam.

Gonzalez RP, Cummings GR, Phelan HA, Bosarge PL, & Rodning CB. Clinical examination in complement with computed tomography scan: An effective method for identification of cervical spine injury. Journal of Trauma Injury, Infection, and Critical Care. (December 2009).