Traditional threshold for retropharyngeal soft-tissue swelling is poorly sensitive for the detection of cervical spine injury on computed tomography in adult trauma patients

Jayme Hiratzka, Jung Yoo, Jia Wei Ko, Natalie L. Zusman, James (Jim) Anderson, Shannon L. Hiratzka, Alexander C. Ching

Research output: Contribution to journalArticle

1 Citation (Scopus)

Abstract

STUDY DESIGN.: Retrospective cohort study. OBJECTIVE.: To examine the diagnostic value of prevertebral soft-tissue swelling in the setting of cervical spine trauma. SUMMARY OF BACKGROUND DATA.: In adult patients with trauma, an increase in the thickness of the retropharyngeal soft tissues is commonly used as a potential indicator of occult injury, but no studies have examined this parameter using computed tomography (CT) as a screening modality. METHODS.: A total of 541 patients with trauma with injuries at any level of the spine underwent CT. Patients with cervical injury were divided into those requiring noninvasive (observation or cervical collar, n = 142) management, and those requiring invasive (surgery or halo, n = 61) treatment. A control group of patients with isolated thoracic or lumbar injuries was used for comparison (n = 542). Retropharyngeal soft tissues were measured at the cranial and caudal endplates of all cervical levels on sagittal and axial CT. Sensitivity and specificity were calculated for +1, +2, and +3 standard deviations from mean values. RESULTS.: Sensitivity for detection of injury was found to be universally poor for all measurement groups. This ranged from 14.4% to 21.2% at +1 SD to 5.3% to 8.7% at +2 SD. Positive and negative predictive values for injury were also universally poor, ranging from 38% to 75%. Soft-tissue swelling as a sentinel sign of cervical spine injury demonstrates consistently high specificity and low sensitivity, precisely the opposite of what would be desired in a screening test. This study shows at best a sensitivity of 21.6% when using this parameter for the detection of these injuries in adult patients with trauma. CONCLUSION.: On the basis of the results of this study, we recommend against the routine use of measurement of the prevertebral soft tissues on CT as a screening tool for cervical spine injury in adult patients with trauma.

Original languageEnglish (US)
JournalSpine
Volume38
Issue number4
DOIs
StatePublished - Feb 15 2013

Fingerprint

Spine
Tomography
Wounds and Injuries
Sensitivity and Specificity
Cohort Studies
Thorax
Retrospective Studies
Observation
Control Groups

Keywords

  • cervical spine
  • prevertebral
  • retropharyngeal
  • swelling
  • trauma

ASJC Scopus subject areas

  • Clinical Neurology
  • Orthopedics and Sports Medicine

Cite this

Traditional threshold for retropharyngeal soft-tissue swelling is poorly sensitive for the detection of cervical spine injury on computed tomography in adult trauma patients. / Hiratzka, Jayme; Yoo, Jung; Ko, Jia Wei; Zusman, Natalie L.; Anderson, James (Jim); Hiratzka, Shannon L.; Ching, Alexander C.

In: Spine, Vol. 38, No. 4, 15.02.2013.

Research output: Contribution to journalArticle

@article{0827d8709be24cf1bf1bac540e7b8d14,
title = "Traditional threshold for retropharyngeal soft-tissue swelling is poorly sensitive for the detection of cervical spine injury on computed tomography in adult trauma patients",
abstract = "STUDY DESIGN.: Retrospective cohort study. OBJECTIVE.: To examine the diagnostic value of prevertebral soft-tissue swelling in the setting of cervical spine trauma. SUMMARY OF BACKGROUND DATA.: In adult patients with trauma, an increase in the thickness of the retropharyngeal soft tissues is commonly used as a potential indicator of occult injury, but no studies have examined this parameter using computed tomography (CT) as a screening modality. METHODS.: A total of 541 patients with trauma with injuries at any level of the spine underwent CT. Patients with cervical injury were divided into those requiring noninvasive (observation or cervical collar, n = 142) management, and those requiring invasive (surgery or halo, n = 61) treatment. A control group of patients with isolated thoracic or lumbar injuries was used for comparison (n = 542). Retropharyngeal soft tissues were measured at the cranial and caudal endplates of all cervical levels on sagittal and axial CT. Sensitivity and specificity were calculated for +1, +2, and +3 standard deviations from mean values. RESULTS.: Sensitivity for detection of injury was found to be universally poor for all measurement groups. This ranged from 14.4{\%} to 21.2{\%} at +1 SD to 5.3{\%} to 8.7{\%} at +2 SD. Positive and negative predictive values for injury were also universally poor, ranging from 38{\%} to 75{\%}. Soft-tissue swelling as a sentinel sign of cervical spine injury demonstrates consistently high specificity and low sensitivity, precisely the opposite of what would be desired in a screening test. This study shows at best a sensitivity of 21.6{\%} when using this parameter for the detection of these injuries in adult patients with trauma. CONCLUSION.: On the basis of the results of this study, we recommend against the routine use of measurement of the prevertebral soft tissues on CT as a screening tool for cervical spine injury in adult patients with trauma.",
keywords = "cervical spine, prevertebral, retropharyngeal, swelling, trauma",
author = "Jayme Hiratzka and Jung Yoo and Ko, {Jia Wei} and Zusman, {Natalie L.} and Anderson, {James (Jim)} and Hiratzka, {Shannon L.} and Ching, {Alexander C.}",
year = "2013",
month = "2",
day = "15",
doi = "10.1097/BRS.0b013e31827f0dc3",
language = "English (US)",
volume = "38",
journal = "Spine",
issn = "0362-2436",
publisher = "Lippincott Williams and Wilkins",
number = "4",

}

TY - JOUR

T1 - Traditional threshold for retropharyngeal soft-tissue swelling is poorly sensitive for the detection of cervical spine injury on computed tomography in adult trauma patients

AU - Hiratzka, Jayme

AU - Yoo, Jung

AU - Ko, Jia Wei

AU - Zusman, Natalie L.

AU - Anderson, James (Jim)

AU - Hiratzka, Shannon L.

AU - Ching, Alexander C.

PY - 2013/2/15

Y1 - 2013/2/15

N2 - STUDY DESIGN.: Retrospective cohort study. OBJECTIVE.: To examine the diagnostic value of prevertebral soft-tissue swelling in the setting of cervical spine trauma. SUMMARY OF BACKGROUND DATA.: In adult patients with trauma, an increase in the thickness of the retropharyngeal soft tissues is commonly used as a potential indicator of occult injury, but no studies have examined this parameter using computed tomography (CT) as a screening modality. METHODS.: A total of 541 patients with trauma with injuries at any level of the spine underwent CT. Patients with cervical injury were divided into those requiring noninvasive (observation or cervical collar, n = 142) management, and those requiring invasive (surgery or halo, n = 61) treatment. A control group of patients with isolated thoracic or lumbar injuries was used for comparison (n = 542). Retropharyngeal soft tissues were measured at the cranial and caudal endplates of all cervical levels on sagittal and axial CT. Sensitivity and specificity were calculated for +1, +2, and +3 standard deviations from mean values. RESULTS.: Sensitivity for detection of injury was found to be universally poor for all measurement groups. This ranged from 14.4% to 21.2% at +1 SD to 5.3% to 8.7% at +2 SD. Positive and negative predictive values for injury were also universally poor, ranging from 38% to 75%. Soft-tissue swelling as a sentinel sign of cervical spine injury demonstrates consistently high specificity and low sensitivity, precisely the opposite of what would be desired in a screening test. This study shows at best a sensitivity of 21.6% when using this parameter for the detection of these injuries in adult patients with trauma. CONCLUSION.: On the basis of the results of this study, we recommend against the routine use of measurement of the prevertebral soft tissues on CT as a screening tool for cervical spine injury in adult patients with trauma.

AB - STUDY DESIGN.: Retrospective cohort study. OBJECTIVE.: To examine the diagnostic value of prevertebral soft-tissue swelling in the setting of cervical spine trauma. SUMMARY OF BACKGROUND DATA.: In adult patients with trauma, an increase in the thickness of the retropharyngeal soft tissues is commonly used as a potential indicator of occult injury, but no studies have examined this parameter using computed tomography (CT) as a screening modality. METHODS.: A total of 541 patients with trauma with injuries at any level of the spine underwent CT. Patients with cervical injury were divided into those requiring noninvasive (observation or cervical collar, n = 142) management, and those requiring invasive (surgery or halo, n = 61) treatment. A control group of patients with isolated thoracic or lumbar injuries was used for comparison (n = 542). Retropharyngeal soft tissues were measured at the cranial and caudal endplates of all cervical levels on sagittal and axial CT. Sensitivity and specificity were calculated for +1, +2, and +3 standard deviations from mean values. RESULTS.: Sensitivity for detection of injury was found to be universally poor for all measurement groups. This ranged from 14.4% to 21.2% at +1 SD to 5.3% to 8.7% at +2 SD. Positive and negative predictive values for injury were also universally poor, ranging from 38% to 75%. Soft-tissue swelling as a sentinel sign of cervical spine injury demonstrates consistently high specificity and low sensitivity, precisely the opposite of what would be desired in a screening test. This study shows at best a sensitivity of 21.6% when using this parameter for the detection of these injuries in adult patients with trauma. CONCLUSION.: On the basis of the results of this study, we recommend against the routine use of measurement of the prevertebral soft tissues on CT as a screening tool for cervical spine injury in adult patients with trauma.

KW - cervical spine

KW - prevertebral

KW - retropharyngeal

KW - swelling

KW - trauma

UR - http://www.scopus.com/inward/record.url?scp=84874110338&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84874110338&partnerID=8YFLogxK

U2 - 10.1097/BRS.0b013e31827f0dc3

DO - 10.1097/BRS.0b013e31827f0dc3

M3 - Article

VL - 38

JO - Spine

JF - Spine

SN - 0362-2436

IS - 4

ER -