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Original Articles
Utility of Spinal Injury Diagnosis Using C-Spine Lateral X-Ray and Chest, Abdomen and Pelvis Computed Tomography in Major Trauma Patients with Impaired Consciousness
Yoon Soo Jang, Byung Hak So, Won Jung Jeong, Kyung Man Cha, Hyung Min Kim
J Trauma Inj. 2018;31(3):151-158.   Published online December 31, 2018
DOI: https://doi.org/10.20408/jti.2018.042
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AbstractAbstract PDF
Purpose

The regional emergency medical centers manage the patients with major blunt trauma according to the process appropriate to each hospital rather than standardized protocol of the major trauma centers. The primary purpose of this study is to evaluate the effectiveness and influence on prognosis of additional cervical-thoracic-lumbar-spine computed tomography (CTL-spine CT) scan in diagnosis of spinal injury from the victim of major blunt trauma with impaired consciousness.

Methods

The study included patients visited the urban emergency medical center with major blunt trauma who were over 18 years of age from January 2013 to December 2016. Data were collected from retrospective review of medical records. Sensitivity, specificity, positive predictive value, and negative predictive value were measured for evaluation of the performance of diagnostic methods.

Results

One hundred patients with Glasgow coma scale ≤13 underwent additional CTL-spine CT scan. Mechanism of injury was in the following order: driver, pedestrian traffic accident, fall and passenger accident. Thirty-one patients were diagnosed of spinal injury, six of them underwent surgical management. The sensitivity of chest, abdomen and pelvis CT (CAP CT) was 72%, specificity 97%, false positive rate 3%, false negative rate 28% and diagnostic accuracy 87%. Eleven patients were not diagnosed of spinal injury with CAP CT and C-spine lateral view, but all of them were diagnosed of stable fractures.

Conclusions

C-spine CT scan be actively considered in the initial examination process. When CAP CT scan is performed in major blunt trauma patients with impaired consciousness, CTL-spine CT scan or simple spinal radiography has no significant effect on the prognosis of the patient and can be performed if necessary.

Summary
The Value of X-ray Compared with Magnetic Resonance Imaging in the Diagnosis of Traumatic Vertebral Fractures
Yang Woo Lee, Jae Ho Jang, Jin Joo Kim, Yong Su Lim, Sung Youl Hyun, Hyuk Jun Yang
J Trauma Inj. 2017;30(4):158-165.   Published online December 30, 2017
DOI: https://doi.org/10.20408/jti.2017.30.4.158
  • 7,570 View
  • 111 Download
  • 2 Citations
AbstractAbstract PDF
Purpose

The purpose of this study was to evaluate the diagnostic accuracy of X-rays in patients with acute traumatic vertebral fractures visiting the emergency department and to analyze the diagnostic value of X-rays for each spine level.

Methods

We retrospectively analyzed basal characteristics by reviewing medical records of 363 patients with adult traumatic vertebral fractures, admitted to the emergency center from March 1, 2014 to February 28, 2017. We analyzed spine X-rays and magnetic resonance imaging (MRI) scans to determine distribution according to the vertebral level, and we evaluated the efficacy of X-rays by comparing discrepancies between X-rays and MRI scans.

Results

For a total of 363 patients, the mean age was 56.65 (20?93) and 214 (59%) were males. On the basis of X-rays, 67 cases (15.1%) were of the cervical spine, 133 cases (30.0%) were of the thoracic spine, and 243 cases (54.9%) were of the lumbar spine. In particular, the thoracolumbar region (T11-L2) was the most common, with 260 cases (58.7%). In X-rays, fractures were the least in the upper thoracic region (T1-T3), whereas MRI scans revealed fairly uniform distribution across the thoracic spine. Sensitivity of X-rays was lowest in the upper thoracic spine and specificity was almost always greater than 98%, except for 94.7% in L1. Positive predictive value was lower in the mid-thoracic region (T4-T9) and negative predictive value was slightly lower in C6, T2, and T3 than at other sites. Diagnostic accuracy of X-rays by vertebral body, transverse process, and spinous process according to fractured vertebral structures was significantly different according to vertebral level.

Conclusions

Diagnostic accuracy of X-rays was lower in the upper thoracic region than in other parts. Further studies are needed to identify better methods for diagnosis considering cost and neurological prognosis.

Summary

Citations

Citations to this article as recorded by  
  • A novel radiological assessment to identify acute vertebral compression fractures: A pilot observational study
    Keisuke Tsuruta, Toru Ueyama, Tomoo Watanabe, Yasunori Kobata, Kenichi Nakano, Hidetada Fukushima
    Acute Medicine & Surgery.2023;[Epub]     CrossRef
  • Forward Bending in Supine Test: Diagnostic Accuracy for Acute Vertebral Fragility Fracture
    Chan-Woo Jung, Jeongik Lee, Dae-Woong Ham, Hyun Kang, Dong-Gune Chang, Youngbae B. Kim, Young-Joon Ahn, Joo Hyun Shim, Kwang-Sup Song
    Healthcare.2022; 10(7): 1215.     CrossRef

J Trauma Inj : Journal of Trauma and Injury