A systematic review found no significant missed injuries in obtunded blunt trauma patients who had normal CT imaging of their cervical spines.
Given the significant morbidity and mortality associated with missed traumatic cervical spine injuries, patients in whom a reliable clinical exam is unobtainable are often evaluated with magnetic resonance imaging (MRI) following a normal computed tomography (CT) scan of the spine. A number of small studies have suggested that an C-spine MRI is not necessary in obtunded patients with a normal CT scan. Now, a systematic review has been performed to determine the utility of MRI after normal CT results in blunt trauma patients who were obtunded (Glasgow Coma Scale score ≤14, unreliable clinical exam, or intubated).
The analysis included seven studies deemed high quality with interpretations by attending-level radiologists using CT scanners with narrow [1 to 3 mm] slice width and multiplanar reconstruction. The studies included a total of 1686 patients. Among patients with normal CT results, there were no injuries identified by MRI or clinical follow-up that were of any clinical consequence.
This systematic review should allow us to avoid the unnecessary and inconvenient C-spine MRI scanning in patients who are obtunded after blunt trauma and have a normal CT scan. These patients do not need a C-spine MRI and can their C-spine can be radiographically cleared with discontinuation of the hard cervical collar with a normal thin-slice CT scan of the C-spine.
Badhiwala JH et al. Cervical spine clearance in obtunded patients after blunt traumatic injury: A systematic review. Ann Intern Med 2015 Mar 17; 162:429.