Diagnostic Value of Bedside Ultrasound for Detecting Cervical Spine Injuries in Patients with Severe Multiple Trauma

Background: Early cervical spine clearance is very important in trauma settings. Waiting for cervical spine clearance by CT scan mandates prolonged cervical spine immobilization and consequently, the delay in subsequent emergency procedures in polytrauma patients.Objectives: The study aimed to assess the value of cervical spine ultrasonography (US) for detecting cervical spine injuries in severe polytrauma patients.Methods: A cross-sectional analytical study was conducted on ۱۷۲ severe polytrauma patients with Glasgow coma scale (GCS) score of < ۱۲ or triage revised trauma score (TRTS) of < ۸. The researcher performed bedside cervical spine US without impeding the ongoing routine trauma management. The researcher was blind to the computed tomography (CT) scan findings. The data were analyzed by SPSS software and sensitivity, specificity, and positive/negative predictive values were determined based on CT findings. The results were also compared between children (≤ ۱۴ year) and adult (> ۱۴ year) age groups.Results: Bedside US had a sensitivity of ۷۴.۵%, specificity of ۹۷.۶%, positive predictive value (PPV) of ۹۲.۱%, negative predictive value (NPV) of ۹۱%, and accuracy of ۹۱.۳% in detecting spinal injuries in comparison with CT findings. Moreover, US had a sensitivity of ۱۰۰%, specificity of ۸۷.۶, PPV of ۵۰%, NPV of ۱۰۰%, and accuracy of ۸۸.۹% in detecting spinal injuries with the movement of fractured or dislocated particles. Also, it had a sensitivity of ۳۳.۳%, specificity of ۸۷.۵۸, PPV of ۱۰۰%, NPV of ۹۷.۲%, and accuracy of ۹۷.۲% in ≤۱۴-year-old patients. The modality had a sensitivity of ۷۶.۲%, specificity of ۹۴.۷, PPV of ۹۱.۴%, NPV of ۸۴.۴%, and accuracy of ۸۶.۹% in > ۱۴-year-old patients.Conclusions: The diagnostic value of bedside US was higher in adults and injured patients with the movement of fractured or dislocated particles.

Keywords:

cervical , fracture , Injury , Multiple Trauma , Ultrasonography