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Impact of MRI on changing management of the cervical spine in blunt trauma patients with a ‘negative’ CT scan
  1. Mohamed A Mohamed,
  2. Karl D Majeske,
  3. Gul Sachwani-Daswani,
  4. Daniel Coffey,
  5. Karim M Elghawy,
  6. Amanda Pham,
  7. Donald Scholten,
  8. Kenneth L Wilson,
  9. Leo Mercer,
  10. Michael L McCann
  1. Hurley Medical Center, Flint, Michigan, USA
  1. Correspondence to Dr Mohamed A Mohamed; mmohame4{at}hurleymc.com

Abstract

Background Owing to the potential risks associated with missed injury, many blunt trauma patients with suspected cervical spine injury undergo some form of imaging technique which has progressed from primarily using plain radiography to relying on CT. Recently, studies have shown that in certain situations, adding MRI may improve the diagnostic accuracy over solely relying on CT.

Methods Retrospective study of 3468 adult blunt trauma patients at a level I trauma center of which 94 with an initial negative CT scan underwent subsequent MRI. These 94 patients were classified as reliable or unreliable for examination; coded as either having a positive or negative MRI result; and assessed for a change in management.

Results Of the 94 patients in the study population, 69 (73.4%) were deemed reliable and 25 (26.6%) deemed unreliable for examination. Overall, 65 (69.1%) patients had a positive MRI result—49 (71.0%) reliable and 16 (64.0%) unreliable—with some patients testing positive for more than one finding. There was no significant difference in positive MRI rates between reliable and unreliable patients. None of the 29 patients who had negative MRI had a change in management, while 31 of the 65 (47.7%) patients with positive MRI did have a change in management of either continued cervical collar immobilization or neck surgery.

Conclusions The use of CT scans should be continued as the primary imaging technique for patients with suspected cervical spine injuries. In cases where obtundation or clinical suspicion exists for a false-negative CT scan, MRI should be considered as a supplement and should not be rejected solely based on the negative result of the CT.

Level of evidence Level IV.

  • cervical spine
  • blunt trauma
  • CT scan
  • MRI

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/

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Footnotes

  • Contributors MAM was the primary author involved and responsible for all aspects of the study. KDM analyzed the data and contributed to the writing of the manuscript. GS-D, DS, KLW, and LM revised and made significant edits to the manuscript. KME,AP, and DC were involved in data collection and revision of the manuscript. MLM revised the manuscript and provided overall supervision of the process.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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