Diagnostic accuracy of clinical examination in cervical spine injuries in awake and alert blunt trauma patients

Study Design: Observational, case series. Purpose: To determine the sensitivity and specificity of clinical judgment as compared to the use of X-ray images in detecting cervical spine injuries in trauma patients presenting in the emergency department of Aga Khan University Hospital, Karachi. Overview of Literature: Cross-table cervical spine views are important in patients with signs and symptoms relating to cervical spine, but asymptomatic patients constitute a different subgroup. Accuracy of clinical examination in these patients has not been subjected to scrutiny. Methods: All patients with blunt trauma who presented to the emergency department and underwent cross-table X-rays as part of their trauma workup were included. The X-rays were read by a radiologist not aware of the history of the patients. We recorded demographic data along with mechanism of injury, associated neck signs or symptoms whether present or not, cervical spine range of motion, associated injuries and X-ray findings. The history and examination were carried out by the on-call neurosurgery team member. The sensitivity and specificity along with negative and positive predictive value of the clinical examination were calculated. Data were analyzed using SPSS ver. 16.0. Results: Of 50 patients with positive signs and symptoms, 4 (8%) had positive X-rays while only 1 out of 324 (0.3%) with no associated signs and symptoms had positive X-ray findings. Conclusions: The clinical examination is 80% sensitive and 73.98% specific in detecting true cervical spine injuries as compared to C-spine X-rays in alert and awake patients with blunt trauma.