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

• Published in: Spine (Philadelphia, Pa. 1976) Vol. 38; no. 4; p. E211
• Main Authors: Hiratzka, Jayme R, Yoo, Jung U, Ko, Jia-Wei, Zusman, Natalie L, Anderson, James C, Hiratzka, Shannon L, Ching, Alexander C
• Format: Journal Article
• Language: English
• Published: United States 15.02.2013
• Subjects: Adolescent; Adult; Aged; Aged, 80 and over; Cervical Vertebrae - diagnostic imaging; Cervical Vertebrae - injuries; Cervical Vertebrae - surgery; Female; Humans; Male; Middle Aged; Predictive Value of Tests; Prognosis; Registries; Retrospective Studies; Sensitivity and Specificity; Soft Tissue Injuries - diagnostic imaging; Spinal Injuries - diagnostic imaging; Spinal Injuries - therapy; Tomography, X-Ray Computed; Young Adult
• ISSN: 1528-1159
• DOI: 10.1097/brs.0b013e31827f0dc3

Retrospective cohort study. To examine the diagnostic value of prevertebral soft-tissue swelling in the setting of cervical spine trauma. 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. 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. 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. 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. 3.