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Frequency and Outcomes of C-spine CT Imaging on Alcohol-intoxicated Patients in the Emergency Department

Published:November 16, 2022DOI:https://doi.org/10.1016/j.jemermed.2022.11.004

      ABSTRACT

      Background

      Cervical spinal injuries range greatly in severity from minor ligamentous injuries to osteo-ligamentous instability with spinal cord injuries. Initial evaluation begins with stabilization as needed and immediate immobilization. Current practices as to whether the c-spine can be cleared clinically without radiographic evaluation are often guided by using the National Emergency X-Radiography Utilization Study (NEXUS) Low-Risk Criteria and the Canadian C-Spine Rule. Under these clinical decision guidelines, stable trauma patients presenting with alcohol intoxication cannot have the c-spine cleared clinically and imaging should be “considered.”

      Objectives

      This study aims to assess the frequency of CT c-spine scans ordered for patients presenting with alcohol intoxication to the emergency department (ED), the timing of the studies, and subsequently determine the proportion of which showed a clinically significant result that required intervention. Methods: In this retrospective medical record review, all clinically alcohol-intoxicated patients presenting to two academic EDs were included. Overall demographics, time to order of CT imaging, radiology reads, and outcome of patient visits were determined

      Results

      8008 patient visits were included in the study. Of these visits, 5 patients scanned in ≤ 3 hours had acute findings on CT scan, whereas no patients with a deferred timing of the CT scan after patients metabolized had an acute finding on CT scan. No patients required operative management

      Conclusion

      This study suggests that it is a safe clinical practice to defer CT imaging for patients presenting to the ED with alcohol intoxication and low suspicion for cervical spine injury per history and exam.

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