Journal Article10.1016/J.JACR.2007.08.006
ACR Appropriateness Criteria® on Suspected Spine Trauma
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TL;DR: The evaluation of patients with suspected spine trauma is controversial, and which patients need imaging, how much imaging is necessary, and exactly what sort of imaging is to be performed are addressed.
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Abstract: The evaluation of patients with suspected spine trauma is controversial. This document addresses several pertinent issues: (1) which patients need imaging, (2) how much imaging is necessary, and (3) exactly what sort of imaging is to be performed. This subject is important, because conservative estimates indicate that more than 1 million blunt trauma patients, who have the potential for sustaining spine injuries, are seen annually in emergency departments in the United States. Adult patients who satisfy any of several "low-risk" criteria for cervical spine injury need no imaging. Patients who do not fall into this category should undergo thin-section computed tomographic examinations that includes sagittal and coronal multiplanar reconstructed images. For those patients who cannot be examined using computed tomography, 3-view radiographic examinations of the cervical vertebrae may be performed to provide preliminary assessments of the likelihood of injury until computed tomography can be performed. Thoracic and lumbar computed tomographic images may be obtained from data collected for thorax-abdomen-pelvis studies. Radiography is recommended for children under 14 years of age. Reconstructed computed tomographic images may be used from thorax-abdomen-pelvis studies of children, if they have been obtained. Magnetic resonance imaging should be the primary modality for evaluating possible spinal cord injury or compression as well as ligamentous injuries in acute cervical spine trauma. Flexion and extension radiography is best reserved for follow-up of symptomatic patients, after neck pain has subsided.
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Citations
The American College of Radiology. ACR Appropriateness Criteria project.
TL;DR: Procedure Appropriateness Category Relative Radiation Level Radiography area of interest Usually Appropriate Varies CT area ofinterest with IV contrast Usually Not AppropriateVaries CT areas of interest without and with IV Contrast Usually Not appropriating Varies FDG-PET/CT whole body Usually not Appropriate.
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ACR Appropriateness Criteria Low Back Pain.
Nandini D. Patel,Daniel F. Broderick,Judah Burns,Tejaswini Deshmukh,Ian Blair Fries,H. Benjamin Harvey,Langston T. Holly,Christopher H. Hunt,Bharathi D. Jagadeesan,Tabassum A. Kennedy,John E. O'Toole,Joel S. Perlmutter,Bruno Policeni,Joshua M. Rosenow,Jason W. Schroeder,Matthew T Whitehead,Rebecca S. Cornelius,Amanda S. Corey +17 more
TL;DR: Imaging is considered in patients who have had up to 6 weeks of medical management and physical therapy that resulted in little or no improvement in their back pain, and for patients presenting with red flags raising suspicion for serious underlying conditions, such as cauda equina syndrome.
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Role of magnetic resonance imaging in acute spinal trauma: a pictorial review
TL;DR: A pictorial review of the normal anatomy of various ligamentous structures in spinal trauma patients and the role of MRI in diagnosing spinal cord and soft tissue injuries is discussed.
Imaging of Atlanto-Occipital and Atlantoaxial Traumatic Injuries: What the Radiologist Needs to Know.
TL;DR: The imaging findings of important CCJ injuries, such as atlanto-occipital dissociation, occipital condyle fractures, atlas fractures with transverse ligament rupture, atlanteaxial distraction, and traumatic rotatory subluxation, are important to recognize in the acute setting, often dictating patient management.
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References
The Canadian C-spine Rule for radiography in alert and stable trauma patients
Ian G. Stiell,George A. Wells,Katherine L. Vandemheen,Catherine M. Clement,Howard Lesiuk,Valerie J. De Maio,Andreas Laupacis,Michael J. Schull,R. Douglas McKnight,Richard Verbeek,Robert J. Brison,Daniel Cass,Jonathan Dreyer,Mary A. Eisenhauer,Gary H. Greenberg,Iain MacPhail,Laurie J. Morrison,Mark Reardon,James Worthington +18 more
TL;DR: The Canadian C-Spine Rule is derived, a highly sensitive decision rule that will allow emergency department (ED) physicians to be more selective in use of radiography in alert and stable trauma patients and has the potential to significantly reduce practice variation and inefficiency in ED use of C-spine radiography.
Validity of a set of clinical criteria to rule out injury to the cervical spine in patients with blunt trauma. National Emergency X-Radiography Utilization Study Group.
TL;DR: A prospective, observational study of a set of clinical criteria that can identify patients who have an extremely low probability of injury and who consequently have no need for imaging studies, which identified all but 8 of the 818 patients who had cervical-spine injury.
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The Canadian C-Spine Rule versus the NEXUS Low-Risk Criteria in Patients with Trauma
Ian G. Stiell,Catherine M. Clement,R. Douglas McKnight,Robert J. Brison,Michael J. Schull,Brian H. Rowe,James Worthington,Mary A. Eisenhauer,Daniel Cass,Gary H. Greenberg,Iain MacPhail,Jonathan Dreyer,Jacques S. Lee,Glen Bandiera,Mark Reardon,Brian R. Holroyd,Howard Lesiuk,George A. Wells +17 more
TL;DR: For alert patients with trauma who are in stable condition, the CCR is superior to the NLC with respect to sensitivity and specificity for cervical-spine injury, and its use would result in reduced rates of radiography.
Prospective screening for blunt cerebrovascular injuries: analysis of diagnostic modalities and outcomes.
Preston R. Miller,Timothy C. Fabian,Martin A. Croce,Catherine Cagiannos,J. Scott Williams,Meng Vang,Waleed G. Qaisi,Richard E. Felker,Shelly D. Timmons +8 more
TL;DR: Aggressive screening of patients with blunt head and neck trauma identified an incidence of BCVI in 1.03% of blunt admissions, and early identification, which led to early treatment, significantly reduced stroke rates in patients with VAI, but provided no outcome improvement with CAI.
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The subaxial cervical spine injury classification system: a novel approach to recognize the importance of morphology, neurology, and integrity of the disco-ligamentous complex.
Alexander R. Vaccaro,R. John Hulbert,Alpesh A. Patel,Charles G. Fisher,Marcel F. Dvorak,Ronald A. Lehman,Paul A. Anderson,James S. Harrop,F. C. Oner,Paul Arnold,Michael G. Fehlings,Rune Hedlund,Ignacio Madrazo,Glenn R. Rechtine,Bizhan Aarabi,Mike Shainline +15 more
TL;DR: The Sub-axial Injury Classification and Severity Scale provides a comprehensive classification system for subaxial cervical trauma and compares favorably to the Harris and Ferguson & Allen systems.
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