Abstract
Objective: To derive a clinical decision rule for cervical spine computed tomography (CT) in patients with blunt trauma to the head or neck.
Methods: The derivation study included 1,076 patients with blunt trauma to the head or neck brought by ambulance to the National Center for Global Health and Medicine (NCGM) Hospital in Japan between April 1, 2008 to August 14, 2010, and who underwent CT of the cervical spine. Another 887 patients who were brought by ambulance to the NCGM between August 15, 2010 and December 31, 2010 were enrolled into the validation study. Patient data for both the derivation and validation studies were collected by retrospectively reviewing medical records. Cervical spine injury (CSI) was defined by fracture or luxation.
Results: Among potential predictors, age, posterior cervical tenderness, neurological deficit and Glasgow coma scale (GCS) score were significantly associated with CSI. Falling down stairs was also significantly associated with CSI in the subgroup ≥60 years old. Using recursive partitioning analysis, we produced a new decision rule with 100% sensitivity for detecting CSI using GCS score, posterior cervical tenderness, neurological deficit and mechanism of injury. Cervical spine CT is recommended for patients with: 1) GCS score ≤13; 2) posterior cervical tenderness or neurological deficit, and GCS score 14-15; 3) age ≥60 years who have fallen down stairs; or 4) age <60 who have been injured in a motorcycle collision or fallen from height.
Conclusion: Our new decision rule using not only GCS score and clinical cervical symptoms, but also age and mechanism of injury, is very sensitive and helpful in diagnosing CSI.
