Cervical Spine Clearance in Obtunded Blunt Trauma Patients: A Prospective Study

This prospective study of 402 obtunded blunt trauma patients compared the accuracy of computed tomography (CT) scanning vs. dynamic radiographs for the detection of unstable cervical spine (C-spine) injuries. Patients included in the study underwent both a CT scan and flexion-extension radiographs of the C-spine. There was one injury that was missed on CT scan but detected on dynamic radiographs, resulting in a percentage of missed injury of 0.25%. Subsequent independent review of the CT scan showed that pathologic changes indicative of injury were present on the initial CT scan. The authors conclude that CT is highly sensitive for the detection of clinically significant C-spine injuries and suggest that CT be used as the sole modality to radiographically clear the C-spine in obtunded trauma patients.