Do cervical spine X-rays for trauma have clinically significant incidental findings?
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ORIGINAL ARTICLE
Do cervical spine X-rays for trauma have clinically significant incidental findings? L. Koren • A. Simonovich • D. Norman S. Israelit • M. Jerdev • R. Sherter • Y. Yagil • R. Rozenberg • E. Peled
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Received: 6 February 2013 / Accepted: 8 April 2013 Ó Springer-Verlag Berlin Heidelberg 2013
Abstract Objectives About 800,000 cervical X-rays for trauma are taken every year in the USA. Those X-rays are reviewed by orthopedic specialists in the emergency room (ER) for traumatic findings. The quantity of incidental atraumatic findings in this very prevalent examination is unknown. We sought to determine the incidence of those findings. Methods We retrospectively reviewed 521 consecutive cervical X-rays of patients with a whiplash injury that visited our ER from February to July 2010. X-rays that were technically insufficient were excluded. This left 356 X-rays that met the inclusion criteria, which were analyzed for incidental findings. The examinations were reviewed by five staff radiologists for incidental findings. The findings were reviewed and classified. Results We identified incidental X-ray findings in 22 of the 356 patients (6.2 %) who underwent X-ray of the cervical spine during their visit to the ER. Stenosis with disk narrowing was the most common finding (2.8 %), followed by congenital anomaly of the cervical spine (2.2 %). Other findings were enlarged sella turcica (0.6 %), carotid atherosclerosis (0.3 %), and calcification of the stylomastoid
L. Koren (&) D. Norman E. Peled Division of Orthopedics, Rambam Health Care Campus, P.O. Box 9602, Haifa 31096, Israel e-mail: [email protected] A. Simonovich M. Jerdev R. Sherter Y. Yagil R. Rozenberg Department of Radiology, Rambam Health Care Campus, Haifa, Israel S. Israelit Department of Emergency Medicine, Rambam Health Care Campus, Haifa, Israel
ligament (0.3 %). Older age was found to be a risk factor for an incidental finding (p \ 0.0001). Conclusion Incidental findings in the cervical spine were associated with older age. Awareness of the prevalence of incidental findings is important in order to ensure that they are detected and managed appropriately. Keywords
Cervical Trauma Incidental findings
Introduction More than 300 persons per 100,000 in the population are seen in emergency rooms (ERs) in the United States (US) every year with a whiplash injury [1, 2]. The Quebec Task Force on Whiplash-Associated Disorders defined whiplash as ‘‘an acceleration–deceleration mechanism of energy transferred to the neck that results in soft tissue injury that may lead to a variety of clinical manifestations including neck pain and its associated symptoms’’ [3]. X-ray is the standard technique for screening low-risk patients with whiplash injuries [4] and is widely used for this purpose. About 800,000 X-rays are taken annually in the US alone for the evaluation of whiplash injuries [5]. A study on computed tomography (CT) scans taken for the evaluation of cervical trauma showed that there is a significant prevalence (18.3 %) of
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