CT Alone for Cervical Spine Clearance in Intoxicated Patients

Because computed tomography (CT) is considered insensitive for ligamentous injuries, many intoxicated patients with concern for cervical spine injury are kept in a cervical collar or undergo magnetic resonance imaging (MRI), even after a normal CT scan. Growing evidence questions whether truly unstable injuries are missed by modern CT. These researchers prospectively assessed rates of spinal injuries missed by modern cervical spine CT scans in 1668 patients at a level 1 trauma center during a 1-year period. CT scans were performed with 2-mm slice thickness and were interpreted in real time by board-certified radiologists.

Overall, 632 patients (44%) were intoxicated (defined as positive urine drug screen or blood alcohol level >80 mg/dL), an…