Nima Kokabi, Presenter: Nothing to Disclose

Daniel M. S. Raper BA, Abstract Co-Author: Nothing to Disclose

Minzhi Xing MBBS, BS, Abstract Co-Author: Nothing to Disclose

Bruno Mario Giuffre MBBS, Abstract Co-Author: Nothing to Disclose

Safe and efficient exclusion of cervical spine injury in victims of blunt trauma is a controversial issue amongst health professionals. While conventional plain radiographs are less sensitive than CT scans, concerns have been raised about the cost and radiation dosage associated with cervical spine CTs. Unnecessary CT scans have been ordered with increased frequency in major trauma centers. Goergen proposed an algorithm combining the validated NEXUS and Hanson’s criteria to stratify blunt trauma victims into low, moderate and high-risk groups (Attached Figure). The objective of this study was to determine the efficacy of Goergen’s algorithm in exclusion of cervical spine injuries.

One hundred and seven victims of blunt trauma aged 16 or older presenting to a Level-1 trauma center were included in the study. All subjects underwent a cervical spine CT. Goergen’s diagnostic algorithm was retrospectively applied based on the information found in patients’ medical records. The proportion of significant cervical spine injuries in the group where Goergen’s algorithm was followed was then compared to the group for whom the algorithm was not followed.

Overall, 9 cases of acute cervical spine injury were diagnosed in our study series. If Goergen’s diagnostic algorithm had been used from the outset, 50 out of 107 patients would be classified as ‘high risk’ requiring CT scan as the primary investigation. All nine acute cervical injury cases would be categorized in this group with no compromise in their management. In the remaining 57 patients, there was one cervical spine injury where CT scan demonstrated an old fracture. In this patient a follow-up MRI did not demonstrate any acute injury not requiring any ongoing treatment. Hence, a statistically significant larger number of significant cervical spine injuries were detected when Goergen’s algorithm was followed(p-value<0.001).

Using Goergen’s diagnostic algorithm, one can effectively stratify blunt trauma victims based on risk of cervical spine injury. This guideline could assist physicians in choosing the most appropriate imaging modality based on the victims’ risk and thereby reduce the number of unnecessary CT scans.

The diagnostic algorithm investigated can significantly reduce the number of unnecessary imaging of cervical spine in casualty units.

Kokabi, N, Raper, D, Xing, M, Giuffre, B, The Efficacy of Goergen's Diagnostic Algorithm in Stratifying Blunt Trauma Victims Based on Their Risk of Sustaining Cervical Spine Injury.  Radiological Society of North America 2010 Scientific Assembly and Annual Meeting, November 28 - December 3, 2010 ,Chicago IL. http://archive.rsna.org/2010/9006442.html