Utility of prevertebral soft tissue measurements in identifying patients with cervical spine fractures

Daniel J. DeBehnke, Charles J. Havel

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Abstract

Study objective: Prevertebral soft tissue measurements ofmore than 6 mm at C2 and more than 22 mm at C6 have been reported as radiologic evidence of cervical spine injury. The objective of this study was to determine the sensitivity and specificity of solft tissue measurements in patients with radiographically proven cervical spine fractures. Design: Retrospective case control study. Setting: Level L trauma center emergency department. Participants: The study group consisted of patients admitted between January 1989 and August 1991 with an admitting or discharge diagnosis of cervical spine fracture. The control group was a systematic sampling of trauma patients seen in the ED during July 1991 who received a cervical spine radiograph. Patients less than 17 years old with penetrating injuries or injuries more than 24 hours old were excluded. One hundred thirty-eight study patients and 134 control patients were identified; 32 study patients and 41 control patients were excluded due to inaccessible records. One hundred six study patients and 93 control patients were used for data analysis. Results: Study patients were divided into two groups: thosewith fractures at C1-C4 (n=55) or C4-C7 (n=86). A C2 prevertebral soft tissue measurement of more than 6 mm had a sensitivity of 59% and a specificity of 84% for fractures at C1-C4. A C6 prevertebral soft tissue measurement of more than 22 mm had a sensitivity of 5% and a specificity of 95% for fractures at C4-C7. Receiver operator characteristic curves for measurements at C2 and C5 failed to demonstrate a cutoff value with adequate sensitivity and specificity in detecting fracture. Conclusion: We conclude that using prevertebral soft tissuemeasurements of more than 6 mm at C2 and more than 22 mm at C6 as a marker of cervical spine injury fails to identify a large proportion of patients with cervical spine fractures.

Original languageEnglish (US)
Pages (from-to)1119-1124
Number of pages6
JournalAnnals of emergency medicine
Volume24
Issue number6
DOIs
StatePublished - Dec 1994

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Spine
Wounds and Injuries
Sensitivity and Specificity
Trauma Centers
Case-Control Studies
Hospital Emergency Service
Control Groups

ASJC Scopus subject areas

  • Emergency Medicine

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Utility of prevertebral soft tissue measurements in identifying patients with cervical spine fractures. / DeBehnke, Daniel J.; Havel, Charles J.

In: Annals of emergency medicine, Vol. 24, No. 6, 12.1994, p. 1119-1124.

Research output: Contribution to journalArticle

DeBehnke, Daniel J. ; Havel, Charles J. / Utility of prevertebral soft tissue measurements in identifying patients with cervical spine fractures. In: Annals of emergency medicine. 1994 ; Vol. 24, No. 6. pp. 1119-1124.
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abstract = "Study objective: Prevertebral soft tissue measurements ofmore than 6 mm at C2 and more than 22 mm at C6 have been reported as radiologic evidence of cervical spine injury. The objective of this study was to determine the sensitivity and specificity of solft tissue measurements in patients with radiographically proven cervical spine fractures. Design: Retrospective case control study. Setting: Level L trauma center emergency department. Participants: The study group consisted of patients admitted between January 1989 and August 1991 with an admitting or discharge diagnosis of cervical spine fracture. The control group was a systematic sampling of trauma patients seen in the ED during July 1991 who received a cervical spine radiograph. Patients less than 17 years old with penetrating injuries or injuries more than 24 hours old were excluded. One hundred thirty-eight study patients and 134 control patients were identified; 32 study patients and 41 control patients were excluded due to inaccessible records. One hundred six study patients and 93 control patients were used for data analysis. Results: Study patients were divided into two groups: thosewith fractures at C1-C4 (n=55) or C4-C7 (n=86). A C2 prevertebral soft tissue measurement of more than 6 mm had a sensitivity of 59{\%} and a specificity of 84{\%} for fractures at C1-C4. A C6 prevertebral soft tissue measurement of more than 22 mm had a sensitivity of 5{\%} and a specificity of 95{\%} for fractures at C4-C7. Receiver operator characteristic curves for measurements at C2 and C5 failed to demonstrate a cutoff value with adequate sensitivity and specificity in detecting fracture. Conclusion: We conclude that using prevertebral soft tissuemeasurements of more than 6 mm at C2 and more than 22 mm at C6 as a marker of cervical spine injury fails to identify a large proportion of patients with cervical spine fractures.",
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