Diagnostic Value of Bedside Ultrasound for Detecting Cervical Spine Injuries in Patients with Severe Multiple Trauma

Document Type: Original Article

Authors

1 Department of Emergency Medicine, Tabriz University of Medical Sciences, Tabriz, Iran

2 Tabriz University of Medical Sciences, Tabriz, Iran

Abstract

Background: Early cervical spine clearance is very important in trauma settings. Waiting for cervical spine clearance by CT scan mandates prolonged cervical spine immobilization and consequently, the delay in subsequent emergency procedures in polytrauma patients.
Objectives: The study aimed to assess the value of cervical spine ultrasonography (US) for detecting cervical spine injuries in severe polytrauma patients.
Methods: A cross-sectional analytical study was conducted on 172 severe polytrauma patients with Glasgow coma scale (GCS) score of < 12 or triage revised trauma score (TRTS) of < 8. The researcher performed bedside cervical spine US without impeding the ongoing routine trauma management. The researcher was blind to the computed tomography (CT) scan findings. The data were analyzed by SPSS software and sensitivity, specificity, and positive/negative predictive values were determined based on CT findings. The results were also compared between children (≤ 14 year) and adult (> 14 year) age groups.
Results: Bedside US had a sensitivity of 74.5%, specificity of 97.6%, positive predictive value (PPV) of 92.1%, negative predictive value (NPV) of 91%, and accuracy of 91.3% in detecting spinal injuries in comparison with CT findings. Moreover, US had a sensitivity of 100%, specificity of 87.6, PPV of 50%, NPV of 100%, and accuracy of 88.9% in detecting spinal injuries with the movement of fractured or dislocated particles. Also, it had a sensitivity of 33.3%, specificity of 87.58, PPV of 100%, NPV of 97.2%, and accuracy of 97.2% in ≤14-year-old patients. The modality had a sensitivity of 76.2%, specificity of 94.7, PPV of 91.4%, NPV of 84.4%, and accuracy of 86.9% in > 14-year-old patients.
Conclusions: The diagnostic value of bedside US was higher in adults and injured patients with the movement of fractured or dislocated particles.

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