PDF(Pubmed)
Abstract：
BACKGROUND: Computed Tomography (CT) is the gold standard for cervical spine (c-spine) evaluation. Magnetic resonance imaging (MRI) emerges due to its increasing availability and the lack of radiation exposure. However, MRI is costly and time-consuming, questioning its role in the emergency department (ED). This study investigates the added the value of an additional MRI for patients presenting with a c-spine injury in the ED.
METHODS: We conducted a retrospective monocenter cohort study that included all patients with neck trauma presenting in the ED, who received imaging based on the NEXUS criteria. Spine surgeons performed a full-case review to classify each case into \"c-spine injured\" and \"c-spine uninjured\". Injuries were classified according to the AO Spine classification. We assessed patients with a c-spine injury detected by CT, who received a subsequent MRI. In this subset, injuries were classified separately in both imaging modalities. We monitored the treatment changes after the additional MRI to evaluate characteristics of this cohort and the impact of the AO Spine Neurology/Modifier modifiers.
RESULTS: We identified 4496 subjects, 2321 were eligible for inclusion and 186 were diagnosed with c-spine injuries in the retrospective case review. Fifty-six patients with a c-spine injury initially identified through CT received an additional MRI. The additional MRI significantly extended (geometric mean ratio 1.32, p < 0.001) the duration of the patients\' stay in the ED. Of this cohort, 25% had a change in treatment strategy and among the patients with neurological symptoms (AON ≥ 1), 45.8% experienced a change in treatment. Patients that were N-positive, had a 12.4 (95% CI 2.7-90.7, p < 0.01) times higher odds of a treatment change after an additional MRI than neurologically intact patients.
CONCLUSIONS: Our study suggests that patients with a c-spine injury and neurological symptoms benefit from an additional MRI. In neurologically intact patients, an additional MRI retains value only when carefully evaluated on a case-by-case basis.
METHODS: We conducted a retrospective monocenter cohort study that included all patients with neck trauma presenting in the ED, who received imaging based on the NEXUS criteria. Spine surgeons performed a full-case review to classify each case into \"c-spine injured\" and \"c-spine uninjured\". Injuries were classified according to the AO Spine classification. We assessed patients with a c-spine injury detected by CT, who received a subsequent MRI. In this subset, injuries were classified separately in both imaging modalities. We monitored the treatment changes after the additional MRI to evaluate characteristics of this cohort and the impact of the AO Spine Neurology/Modifier modifiers.
RESULTS: We identified 4496 subjects, 2321 were eligible for inclusion and 186 were diagnosed with c-spine injuries in the retrospective case review. Fifty-six patients with a c-spine injury initially identified through CT received an additional MRI. The additional MRI significantly extended (geometric mean ratio 1.32, p < 0.001) the duration of the patients\' stay in the ED. Of this cohort, 25% had a change in treatment strategy and among the patients with neurological symptoms (AON ≥ 1), 45.8% experienced a change in treatment. Patients that were N-positive, had a 12.4 (95% CI 2.7-90.7, p < 0.01) times higher odds of a treatment change after an additional MRI than neurologically intact patients.
CONCLUSIONS: Our study suggests that patients with a c-spine injury and neurological symptoms benefit from an additional MRI. In neurologically intact patients, an additional MRI retains value only when carefully evaluated on a case-by-case basis.
摘要：
背景：计算机断层扫描（CT）是颈椎（c-spine）评估的金标准。磁共振成像（MRI）由于其日益增加的可用性和缺乏辐射暴露而出现。然而,MRI既昂贵又耗时,质疑其在急诊科（ED）中的作用。这项研究调查了在ED中出现c脊柱损伤的患者增加MRI的价值。
方法：我们进行了一项回顾性单中心队列研究，包括所有在ED中出现颈部外伤的患者，根据NEXUS标准接受成像。脊柱外科医生进行了全面审查，将每个病例分为“c-脊柱受伤”和“c-脊柱未受伤”。根据AO脊柱分类对损伤进行分类。我们评估了CT检测到的c脊柱损伤患者，他随后接受了MRI检查。在这个子集中，在两种影像学检查中分别对损伤进行分类.我们监测了额外MRI后的治疗变化，以评估该队列的特征以及AO脊柱神经病学/修饰符修饰符的影响。
结果：我们确定了4496名受试者，在回顾性病例审查中，2321例符合入选条件，186例被诊断为c脊柱损伤。最初通过CT确定的56例c脊柱损伤患者接受了额外的MRI检查。额外的MRI显着延长了患者在ED中的停留时间（几何平均比1.32，p<0.001）。在这个队列中，25%的患者改变了治疗策略，在有神经系统症状的患者中（AON≥1），45.8%经历了治疗改变。N阳性的患者，与神经系统完整的患者相比,额外MRI后治疗改变的几率高12.4倍(95%CI2.7-90.7,p<0.01)。
结论：我们的研究表明，患有脊柱损伤和神经系统症状的患者可以从额外的MRI中获益。在神经系统完整的患者中，只有在逐案仔细评估时,额外的MRI才有价值.
方法：我们进行了一项回顾性单中心队列研究，包括所有在ED中出现颈部外伤的患者，根据NEXUS标准接受成像。脊柱外科医生进行了全面审查，将每个病例分为“c-脊柱受伤”和“c-脊柱未受伤”。根据AO脊柱分类对损伤进行分类。我们评估了CT检测到的c脊柱损伤患者，他随后接受了MRI检查。在这个子集中，在两种影像学检查中分别对损伤进行分类.我们监测了额外MRI后的治疗变化，以评估该队列的特征以及AO脊柱神经病学/修饰符修饰符的影响。
结果：我们确定了4496名受试者，在回顾性病例审查中，2321例符合入选条件，186例被诊断为c脊柱损伤。最初通过CT确定的56例c脊柱损伤患者接受了额外的MRI检查。额外的MRI显着延长了患者在ED中的停留时间（几何平均比1.32，p<0.001）。在这个队列中，25%的患者改变了治疗策略，在有神经系统症状的患者中（AON≥1），45.8%经历了治疗改变。N阳性的患者，与神经系统完整的患者相比,额外MRI后治疗改变的几率高12.4倍(95%CI2.7-90.7,p<0.01)。
结论：我们的研究表明，患有脊柱损伤和神经系统症状的患者可以从额外的MRI中获益。在神经系统完整的患者中，只有在逐案仔细评估时,额外的MRI才有价值.
