Abstract：
BACKGROUND: Cervical spine injuries (CSI) are often challenging to diagnose in obtunded adult patients with blunt trauma and the optimal imaging modality remains uncertain. This study systematically synthesized the last decade of evidence to determine the type of imaging required to clear the c-spine in obtunded patients with blunt trauma.
METHODS: A systematic review with meta-analysis was conducted and reported using PRISMA 2020 guidelines. The protocol was registered on June 22, 2022 (PROSPERO CRD42022341386). MEDLINE (Ovid), EMBASE, and Cochrane Library were searched for studies published between January 1, 2012, and October 17, 2023. Studies comparing CT alone to CT combined with MRI for c-spine clearance were included. Two independent reviewers screened articles for eligibility in duplicate. Meta-analysis was conducted using a random-effect model. Risk of bias and quality assessment were performed using the ROBINS-I and QUADAS-2. The certainty of evidence was assessed using the GRADE methodology.
RESULTS: 744 obtunded trauma patients from six included studies were included. Among the 584 that had a negative CT scan, the pooled missed rate of clinically significant CSI using CT scans alone was 6 % (95 % CI: 0.02 to 0.17), and the pooled missed rate of CSI requiring treatment was 7 % (95 % CI: 0.02 to 0.18). High heterogeneity was observed among included studies (I² > 84 %). The overall risk of bias was moderate, and the quality of evidence was low due to the retrospective nature of the included studies and high heterogeneity.
CONCLUSIONS: Limited evidence published in the last decade found that CT scans alone may not be sufficient for detecting clinically significant CSI and injuries requiring treatment in obtunded adult patients with blunt trauma.
CONCLUSIONS: Clinicians should be aware of the limitations of CT scans and consider using MRI when appropriate. Future research should focus on prospective studies with standardized outcome measures and uniform reporting.
METHODS: A systematic review with meta-analysis was conducted and reported using PRISMA 2020 guidelines. The protocol was registered on June 22, 2022 (PROSPERO CRD42022341386). MEDLINE (Ovid), EMBASE, and Cochrane Library were searched for studies published between January 1, 2012, and October 17, 2023. Studies comparing CT alone to CT combined with MRI for c-spine clearance were included. Two independent reviewers screened articles for eligibility in duplicate. Meta-analysis was conducted using a random-effect model. Risk of bias and quality assessment were performed using the ROBINS-I and QUADAS-2. The certainty of evidence was assessed using the GRADE methodology.
RESULTS: 744 obtunded trauma patients from six included studies were included. Among the 584 that had a negative CT scan, the pooled missed rate of clinically significant CSI using CT scans alone was 6 % (95 % CI: 0.02 to 0.17), and the pooled missed rate of CSI requiring treatment was 7 % (95 % CI: 0.02 to 0.18). High heterogeneity was observed among included studies (I² > 84 %). The overall risk of bias was moderate, and the quality of evidence was low due to the retrospective nature of the included studies and high heterogeneity.
CONCLUSIONS: Limited evidence published in the last decade found that CT scans alone may not be sufficient for detecting clinically significant CSI and injuries requiring treatment in obtunded adult patients with blunt trauma.
CONCLUSIONS: Clinicians should be aware of the limitations of CT scans and consider using MRI when appropriate. Future research should focus on prospective studies with standardized outcome measures and uniform reporting.
摘要：
背景：颈椎损伤（CSI）通常在钝性创伤的成年患者中具有挑战性，并且最佳成像方式仍不确定。这项研究系统地综合了最近十年的证据，以确定在钝性创伤患者中清除c脊柱所需的成像类型。
方法：使用PRISMA2020指南进行了系统评价和荟萃分析。该协议于2022年6月22日注册（PROSPEROCRD42022341386）。MEDLINE(Ovid),EMBASE,和Cochrane图书馆被搜索2012年1月1日至2023年10月17日之间发表的研究。包括比较单独CT与CT结合MRI治疗c脊柱间隙的研究。两名独立审稿人一式两份筛选了文章的资格。采用随机效应模型进行Meta分析。使用ROBINS-I和QUADAS-2进行偏倚风险和质量评估。使用GRADE方法评估证据的确定性。
结果：纳入了来自6项纳入研究的744名肥胖创伤患者。在584名CT扫描阴性的人中，仅使用CT扫描的临床显着CSI的合并漏诊率为6％（95％CI：0.02至0.17），需要治疗的CSI合并漏诊率为7%(95%CI:0.02~0.18).在纳入的研究中观察到高度异质性(I²>84%)。总体偏倚风险中等，由于纳入研究的回顾性性质和高度异质性,证据质量较低.
结论：在过去十年中发表的有限证据发现，仅CT扫描可能不足以检测临床上有意义的CSI和需要治疗的成人钝性创伤患者的损伤。
结论：临床医生应该意识到CT扫描的局限性，并在适当的时候考虑使用MRI。未来的研究应侧重于具有标准化结果测量和统一报告的前瞻性研究。
方法：使用PRISMA2020指南进行了系统评价和荟萃分析。该协议于2022年6月22日注册（PROSPEROCRD42022341386）。MEDLINE(Ovid),EMBASE,和Cochrane图书馆被搜索2012年1月1日至2023年10月17日之间发表的研究。包括比较单独CT与CT结合MRI治疗c脊柱间隙的研究。两名独立审稿人一式两份筛选了文章的资格。采用随机效应模型进行Meta分析。使用ROBINS-I和QUADAS-2进行偏倚风险和质量评估。使用GRADE方法评估证据的确定性。
结果：纳入了来自6项纳入研究的744名肥胖创伤患者。在584名CT扫描阴性的人中，仅使用CT扫描的临床显着CSI的合并漏诊率为6％（95％CI：0.02至0.17），需要治疗的CSI合并漏诊率为7%(95%CI:0.02~0.18).在纳入的研究中观察到高度异质性(I²>84%)。总体偏倚风险中等，由于纳入研究的回顾性性质和高度异质性,证据质量较低.
结论：在过去十年中发表的有限证据发现，仅CT扫描可能不足以检测临床上有意义的CSI和需要治疗的成人钝性创伤患者的损伤。
结论：临床医生应该意识到CT扫描的局限性，并在适当的时候考虑使用MRI。未来的研究应侧重于具有标准化结果测量和统一报告的前瞻性研究。
