Journal article
Utility of computed tomography reconstructed thoracolumbar spinal imaging in blunt trauma
The journal of trauma and acute care surgery, v 95(1), pp 116-121
01 Jul 2023
PMID: 37012636
Featured in Collection : UN Sustainable Development Goals @ Drexel
Abstract
OBJECTIVES: Fractures of the thoracolumbar (TL) spine are common and may cause neurologic damage, pain, and reduced quality of life. Computed tomography (CT) TL reconstructions from CT chest, abdomen, and pelvis (CAP) are used to identify TL fractures; however, their benefit over CAP imaging is unclear. We hypothesized that reformatted TL images do not identify additional clinically significant injuries or change outcomes.
METHODS: Retrospective data were collected 2016 to 2021 from trauma patients at a level 1 trauma center. All patients 18 years or older with TL fractures on CT CAP with/without CT TL reformats were included. Clinically significant TL fractures were defined as requiring operative fixation, brace, or spinal rehabilitation. A binary classification model was created to assess the diagnostic utility of CTCAP compared with CTTL in predicting clinically significant fractures in patients who underwent CT CAP/TL.
RESULTS: There were 828 patients with TL fractures, 634 had both CT CAP/CT TL (CAPTL) and 194 CTCAP only (CAP). There were 134 clinically significant TL fractures (16%) (14 [7.2%] CT CAP vs. 120 [18.9%] CT CAPTL, p < 0.001). There were no differences among unstable fractures, fractures on magnetic resonance imaging (MRI) only, mortality, or neurologic deficits on discharge between CAPTL and CAP (p > 0.05). Among clinically significant fractures, CAPTL was not associated with increased MRI utilization, surgery, spinal brace, or spinal cord rehabilitation (p > 0.05). Among clinically insignificant fractures, CAPTL was associated with increased MRIs, length of stay (LOS), and intensive care unit LOS (p < 0.05). CAPTL was also an independent predictor of increased MRIs (odds ratio, 5.79; 95% confidence interval, 2.29-14.65; p < 0.01) and spine consultation (odds ratio, 2.39; 95% confidence interval, 1.64-3.67; p < 0.01). More CT CAP/TL were performed in those with clinically significant fractures; however, CTCAP was equivalent to CTTL for detection of fractures (p > 0.05).
CONCLUSION: CTCAP alone is sufficient to identify clinically significant TL fractures. While the addition of TL reformatted imaging minimizes missed injuries, it is associated with increased hospital LOS and MRI resource utilization. Therefore, careful consideration is needed for appropriate CT TL patient selection.
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Details
- Title
- Utility of computed tomography reconstructed thoracolumbar spinal imaging in blunt trauma
- Creators
- Abhishek Swarup - Rutgers, The State University of New JerseyChris Amro - Rutgers, The State University of New JerseyRachel L. Choron - Rutgers, The State University of New JerseyAlexander Cong - Reading HospitalJohn Park - Rutgers, The State University of New JerseyChristopher A. Butts - Rutgers, The State University of New JerseyJulie Goswami - Rutgers, The State University of New JerseyAmanda L. Teichman - Rutgers, The State University of New Jersey
- Publication Details
- The journal of trauma and acute care surgery, v 95(1), pp 116-121
- Publisher
- Lippincott Williams & Wilkins
- Number of pages
- 6
- Resource Type
- Journal article
- Language
- English
- Academic Unit
- Surgery
- Web of Science ID
- WOS:001020223600018
- Scopus ID
- 2-s2.0-85163865260
- Other Identifier
- 991021929614704721
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InCites Highlights
Data related to this publication, from InCites Benchmarking & Analytics tool:
- Web of Science research areas
- Critical Care Medicine
- Surgery