Role of clinical examination in screening for blunt cervical spine injury

Richard P. Gonzalez, Peter O. Fried, Mikhail Bukhalo, Michele R. Holevar, Mark Falimirski

Research output: Contribution to journalArticle

63 Citations (Scopus)

Abstract

Background: The purpose of this study was to evaluate the hypothesis that awake and alert blunt trauma patients with Glasgow Coma Scores of 14 or 15 (regardless of blood ethanol level or other injuries sustained) can be effectively evaluated with clinical examination without radiographic evaluation of the cervical spine. Study Design: During a 32-month period at an urban Level 1 Trauma Center, 2,176 consecutive blunt trauma patients who presented with Glasgow Coma Scores of 14 or 15 were prospectively evaluated by trauma resident housestaff. Housestaff performed physical examinations of the neck and questioned the patients for the presence of neck pain. Following study form documentation of the cervical neck examination, a lateral cervical spine x-ray was performed. Further studies such as swimmer's view and CAT scan were performed if the lateral x-ray could not completely evaluate C1 to C7. These further studies were considered part of the lateral cervical spine (c-spine) x-ray screen. Attending radiologists performed final x-ray interpretations. Results: The study consisted of 2,176 patients, 33 (1.6%) of whom were diagnosed with cervical spine injury. Of the 33 patients with cervical spine injury, 3 had negative clinical examinations (sensitivity, 91%). Lateral c-spine x-ray screen was negative in 1 of these 3 patients. The 2 patients with negative c-spine clinical examination but positive lateral c- spine x-ray screens were diagnosed with C2 spinous process fracture and C6-C7 body fractures. Thirteen patients with negative lateral c-spine screens (sensitivity, 61%) were diagnosed with cervical spine injury. We evaluated 463 patients with blood ethanol levels greater than 100 mg/dL, and 6 (1.3%) were diagnosed with c-spine injury. No injuries were missed on clinical examination in this subgroup with elevated blood ethanol levels. Conclusions: 1) Clinical examination of the neck can reliably rule out significant cervical spine injury in the awake and alert blunt trauma patient. Addition of lateral c-spine x-ray does not improve the sensitivity of clinical examination in the diagnosis of significant cervical spine injury. 2) Elevated ethanol level is not a contraindication to the use of clinical examination as the screening tool for cervical spine injury. Level of consciousness, as determined by Glasgow Coma Score, is a more effective criterion to dictate a screening method for cervical spine injury.

Original languageEnglish (US)
Pages (from-to)152-157
Number of pages6
JournalJournal of the American College of Surgeons
Volume189
Issue number2
DOIs
StatePublished - Aug 1999
Externally publishedYes

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Spine
Wounds and Injuries
X-Rays
Ethanol
Coma
Neck
Neck Pain
Trauma Centers
Consciousness
Documentation
Physical Examination

ASJC Scopus subject areas

  • Surgery

Cite this

Role of clinical examination in screening for blunt cervical spine injury. / Gonzalez, Richard P.; Fried, Peter O.; Bukhalo, Mikhail; Holevar, Michele R.; Falimirski, Mark.

In: Journal of the American College of Surgeons, Vol. 189, No. 2, 08.1999, p. 152-157.

Research output: Contribution to journalArticle

Gonzalez, Richard P. ; Fried, Peter O. ; Bukhalo, Mikhail ; Holevar, Michele R. ; Falimirski, Mark. / Role of clinical examination in screening for blunt cervical spine injury. In: Journal of the American College of Surgeons. 1999 ; Vol. 189, No. 2. pp. 152-157.
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