Dataset Information

Diagnostic utility of point of care ultrasound in identifying cervical spine injury in emergency settings.

ABSTRACT:

Introduction

The evaluation of cervical-spine in a major trauma patient needs a bedside efficient tool to rule out cervical spine injury as the role of X-ray and Computed Tomography (CT) in this setting is limited. Point of care ultrasonography (POCUS) is being used as an adjunct during trauma resuscitation. The aim of this study was to evaluate the use of POCUS for identifying cervical spine injuries.

Methods

We recruited 84 cases with cervical spine injury based on CT scan after taking consent. POCUS was used as per the operational definition of study methods while maintaining manual in-line stabilisation. Statistical analysis was done by using STATA version 14.

Results

Normal cervical anatomy was visible through anterior approach in POCUS except for the 1^st and 2^nd cervical vertebrae. The sensitivity and specificity of POCUS vs CT scan for vertebral body listhesis were 84.52% (95% CI of 0.65-0.95) and 89.66% (95% CI 0.78-0.96) with p-value <0.0001. Sensitivity and specificity of POCUS vs CT for vertebral body fracture were 40.91% (95% CI of 0.20-0.63) and 96.77% (95% CI of 0.88-0.99) with p-value <0.0001. The overall sensitivity and specificity of POCUS were 45.83% and 83.33% (p = 0.06) and excluding isolated posterior column injuries, sensitivity and specificity were 70.21% and 83.33% (p < 0.05).

Conclusion

POCUS identified injuries such as fracture and listhesis. Because of high rate of missed injuries, ultrasound at present cannot be used as a screening or diagnostic tool for decision-making in cervical spine injury.

SUBMITTER: Vk V

PROVIDER: S-EPMC8591273 | biostudies-literature |

REPOSITORIES: biostudies-literature

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Project description:Study designGlobal cross-sectional survey.ObjectiveThe aim of this study was to validate the AO Spine Subaxial Cervical Spine Injury Classification by examining the perceived injury severity by surgeon across AO geographical regions and practice experience.Summary of background dataPrevious subaxial cervical spine injury classifications have been limited by subpar interobserver reliability and clinical applicability. In an attempt to create a universally validated scheme with prognostic value, AO Spine established a subaxial cervical spine injury classification involving four elements: injury morphology, facet injury involvement, neurologic status, and case-specific modifiers.MethodsA survey was sent to 272 AO Spine members across all geographic regions and with a variety of practice experience. Respondents graded the severity of each variable of the classification system on a scale from zero (low severity) to 100 (high severity). Primary outcome was to assess differences in perceived injury severity for each injury type over geographic regions and level of practice experience.ResultsA total of 189 responses were received. Overall, the classification system exhibited a hierarchical progression in subtype injury severity scores. Only three subtypes showed a significant difference in injury severity score among geographic regions: F3 (floating lateral mass fracture, P = 0.04), N3 (incomplete spinal cord injury, P = 0.03), and M2 (critical disk herniation, P = 0.04). When stratified by surgeon experience, pairwise comparison showed only two morphological subtypes, B1 (bony posterior tension band injury, P = 0.02) and F2 (unstable facet fracture, P = 0.03), and one neurologic subtype (N3, P = 0.02) exhibited a significant difference in injury severity score.ConclusionThe AO Spine Subaxial Cervical Spine Injury Classification System has shown to be reliable and suitable for proper patient management. The study shows this classification is substantially generalizable by geographic region and surgeon experience, and provides a consistent method of communication among physicians while covering the majority of subaxial cervical spine traumatic injuries.Level of Evidence: 4.