الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
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Abstract
Trauma patients constitute an important subgroup that come to our emergency department. The evaluation and management of cervical spine injuries is a core component of the practice of emergency medicine. all of these patients undergo a cervical spine X-ray. These X-rays are exposing patients to unnecessary radiation.
The aim of this study was to evaluate the diagnostic accuracy of clinical examination of cervical spine injuries in blunt trauma patients presented to Alexandria Main University Hospital Emergency Department. This study was a prospective study conducted on one hundred patients that are subjected to have cervical spine injuries following blunt trauma.
Each patient’s history, clinical examination and radiological images were analyzed. The data included were the patient personal data, causes of the injury, clinical examination of the cases and radiological investigations.
In this study patient population consisted of 100 patients. A majority of them 83 (83.0%) were males. Of the100, 65 (65.0%) less than or equal to 35 years of age while 35 (35.0%) were older. Most 80 (80.0%) were victims of road traffic accidents. Signs and symptoms that were assessed included neck pain, tenderness, and cervical range of motion. Of the 100, 10 (10.0%) had neck symptoms, while the majority, 90 (90.0%), had no neck symptoms. All patients regardless of their neck signs/symptoms underwent X-ray cervical spine cross-table views.
Amongst the 10 symptomatic patients in this study, only 4 (4.0%) had positive cross-table cervical spine X-rays and one case had positive MRI finding. The all patients with no neck signs/symptoms, had negative cross table cervical spine X-rays. Of the 100, 45 (45.0%) had associated injuries, which included craniofacial injury (30, 30.0%), torso and limb injuries (15, 15.0%). Of the 100 patients, 55 (55.0%) had no associated injuries.
The descriptions of the patients with positive cross table cervical spine X-rays were as follows: one patient was 25 years old male, had a C5 fracture, one was 34 years old male patient, had C5/6 dislocation fracture, one was 27 years old male patient, had C6/7 bodies fracture and the last patient was 52 years old male, had a C3 fracture. The first three patients road traffic accidents were the mode of trauma, while falling from height was the mode of trauma in the last patient.
Six patients with neck symptoms had negative X-ray findings had also negative CT and MRI findings, except only one patient who had positive MRI showing injury of the cervical spine ligaments. Three of the 5 patients who had positive finging presented with a history of a road traffic accident, while two had a fall. Interestingly, the one individual who had positive MRI finding, had negative cervical spine X-rays and negative CT, had a fall(FFH) as pure Ligamentous injuries without fracture of the C-spine are rare.
When compared with cross table cervical spine X-rays, the sensitivity, specificity and accuracy of the clinical examination were 100%, 93.75% and 94% respectively. The positive predictive value of the clinical examination was 40% and the negative predictive value was 100%.
So we recommend that All blunt trauma patients who are subjected to cervical spine injuries and asymptomatic do not require radiographic assessment of the cervical spine following trauma.