Carolinas Core Concepts Core Concepts in EM; a repository for Carolinas lecture summaries.

20Jul/118

C-Spine Imaging in the ED

  • In low-risk groups with an adequate c-spine XRay, the negative predictive value is 99.9%.   However, C-spine XRay sensitivity for all comers is only 36-64% and average time-to-dispo is 1.9 hours vs 1 hour on average for CT.
  • CT c-spine disadvantages:  Cancer risk 1:200 in 15 y/o, 1:2,000 in 30 y/o, 1:5,000 in 70 y/o.  Cost is also higher, although when inadequate CSXR and "missed fracture" costs are added in they may be comparable.
  • In the alert patient with a negative CT c-spine but persistent bony tenderness there are three options: continue collar upon discharge, MRI for ligamentous injury, or flex-extension films.
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  1. Re “three options”…there is a fourth…expectant management without further ado.

    Newer pubs with reasonable methodology and power support the fourth option

    Sure you want alums on here?

  2. Sure do, Pat. Good to hear from you!

  3. Great Point Burnside… if only I could get you to comment on my Peds EM Morsels!! Welcome to the fray.

  4. ….also remember for all CT’s “causing cancer” arguments This is theoretical data (albeit sound) based on a linear regression plot with a threshold amount. In-vivo we see more of a non-linear threshold plot with EXTRAPOLATED risk below the threshold value.

    There is still yet to be a single prospective study with correlation.

    Most, if not all data in this field is based on research by Branner which uses extrapolated data with theoretical endpoints.

  5. Dr. Cook has a great point also. The LifeSpan study (which looked at the radiation illnesses following the A-Bombs that were dropped in Japan) are what the “experts” will use to extrapolate the risk for radiation that is delivered at levels we use in the medical field (ex, CTs). No, an A-Bomb doesn’t equal a CT scan… but the LifeSpan studies looked at doses that we can, an do, deliver to our patients. Look at the numbers on the http://www.pedemmorsels.com website… and remember, that this information is even more significant in the younger patients, who have longer to accumulate even more radiation, have longer for a isolated radiation induced mutation to lead to a neoplasm, and have cells that are rapidly dividing and more susceptible to radiation damage.


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