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DOI: 10.1055/s-0039-1692557
The FIST Study: Exploring Clinical Strength of Cervical Spine CT in Determining Need for Stabilizing Treatment in Cervical Spine Injury
Publication History
Publication Date:
04 June 2019 (online)
Purpose: To quantify the clinical value of cervical spine computed tomography (CT) in determining the need for stabilizing treatment in cervical spine trauma.
Methods and Materials: A total of 227 CT scans from patients with acute traumatic cervical spine injuries presenting to our level 1 trauma center in The Netherlands were assessed retrospectively by three experienced neurosurgeons with different backgrounds. The neurosurgeons individually determined whether the fracture(s) present on the scan was a fracture in need of stabilizing therapy (FIST). Stabilizing therapy was defined as either a conservative (rigid cervical collar or HALO traction) or surgical stabilization treatment. Subaxial cervical spine injuries (C3–C7) were classified according to the AOSpine Subaxial Classification System. Clinical information was not provided to optimize objective assessment of the CT scan. Consensus was established on the scans on which the opinion of the neurosurgeons initially differed. Outcomes of the FIST assignment by consensus of the neurosurgeons were compared with the treatment actually provided. Diagnostic accuracy measures were calculated to quantify the clinical value of cervical spine CT in determining the need for stabilizing therapy.
Results: Overall, 152 of 227 cases (67.0%) were assigned as a FIST by the neurosurgeons. In six patients, no information regarding the provided treatment was available. In 121 of 221 cases (54.8%), stabilizing treatment was initiated retrospectively. Agreement between the assignment of (no) FIST by the neurosurgeons and the treatment provided was found in 80.1%. The independent CT assessment without knowledge of clinical information showed a sensitivity of 93.4% and a negative likelihood ratio of 0.1. Table 1 shows other diagnostic accuracy measures.
The neurosurgeons identified all patients who received stabilizing therapy, except for eight cases. Reassessing these cases, the neurosurgeons agreed on the retrospectively provided treatment in five cases because of clinical (neurologic) symptoms and/or the magnetic resonance imaging result, but in the remaining three cases, the neurosurgeons agreed that no indication for stabilizing treatment existed.
A total of 36 cases were assigned as a FIST by consensus of the neurosurgeons but not according to the retrospectively initiated treatment. In one case a soft cervical collar was provided instead of stabilizing therapy because of the advanced age and comorbidities of the patient. In all other cases, no indicators were found of insufficient treatment in the electronic medical records. Therefore, the (most) correct treatment could not be determined.
Conclusion: Even without clinical information, scrupulous assessment of a cervical spine CT enables exclusion of patients in need of stabilizing treatment for traumatic cervical spine injury.
Abbreviations: CI, confidence interval; FIST, fracture in need of stabilizing therapy.