This preprint is under consideration at BMC Emergency Medicine. A preprint is a preliminary version of a manuscript that has not completed peer review at a journal. Research Square does not conduct peer review prior to posting preprints. The posting of a preprint on this server should not be interpreted as an endorsement of its validity or suitability for dissemination as established information or for guiding clinical practice.
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Research Article
John Culhane
Saint Louis University
Corresponding Author
License:
This work is licensed under a CC BY 4.0 License. Read Full License
Background
Clinically occult cervical spine (CS) injuries are well described in blunt trauma, however delay in identifying these injuries and clearing the CS can result in morbidity. Our study examines the ground level fall (GLF) population to analyze whether computed tomography (CT) alone can rule out unstable injury in this group with lower force mechanism.
Methods
This is a single center, retrospective cohort study. Cases of GLF between 6/1/2012 through 12/31/2019 were queried. Characteristics of GLF and non-GLF patients were compared. Significance for categorical data was calculated with Chi Square, Student’s t-test for continuous data, and Mann-Whitney U test for ordinal data. CT negative CS injuries were identified. Binary classification tests were calculated for the ability of CT to identify CS injury using a generalized linear regression model with binomial distribution and identity link.
Results
69 (2.0%) of patients had CS injury without acute CT abnormality. Of these, 11 (0.3%) required surgery and were considered unstable. All patients who required surgery had a neurologic deficit. Negative predictive value (NPV) of CT for unstable CS injury was 99.7%. The combination of acute CT findings and neurologic deficit ruled out unstable CS injury with 100% NPV.
Conclusion
In the GLF population, CT alone rules out unstable CS injury with high, but not perfect NPV. The combination of absence of acute CT findings and acute neurologic deficits rules out unstable CS injury with 100% NPV.
Keywords
Ground Level Fall, Cervical Spine, Clearance, Elderly, Trauma,
No competing interests reported.
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CURRENT STATUS: Under Review
Version 1
Posted 15 Nov, 2021
No community comments so far
Reviewers invited
Invitations sent on 03 Dec, 2021
Editor assigned
On 03 Dec, 2021
Editor invited
On 11 Nov, 2021
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On 11 Nov, 2021
First submitted
On 25 Oct, 2021
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Subject Areas
Critical Care & Emergency Medicine
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This preprint is under consideration at BMC Emergency Medicine. A preprint is a preliminary version of a manuscript that has not completed peer review at a journal. Research Square does not conduct peer review prior to posting preprints. The posting of a preprint on this server should not be interpreted as an endorsement of its validity or suitability for dissemination as established information or for guiding clinical practice.
Learn more about In Review
Research Article
John Culhane
Saint Louis University
Corresponding Author
Badges
Prescreen
This manuscript passed our Prescreen assessment
Complete author information
Appropriate declaration statements
Potential risks to human health
Prescreen
Peer Review Timeline
CURRENT STATUS: Under Review
Version 1
Posted 15 Nov, 2021
No community comments so far
Reviewers invited
Invitations sent on 03 Dec, 2021
Editor assigned
On 03 Dec, 2021
Editor invited
On 11 Nov, 2021
Submission checks complete
On 11 Nov, 2021
First submitted
On 25 Oct, 2021
Metrics
Comments: 0
PDF Downloads: ...
HTML Views: ...
Subject Areas
Critical Care & Emergency Medicine
License:
This work is licensed under a CC BY 4.0 License. Read Full License
Background
Clinically occult cervical spine (CS) injuries are well described in blunt trauma, however delay in identifying these injuries and clearing the CS can result in morbidity. Our study examines the ground level fall (GLF) population to analyze whether computed tomography (CT) alone can rule out unstable injury in this group with lower force mechanism.
Methods
This is a single center, retrospective cohort study. Cases of GLF between 6/1/2012 through 12/31/2019 were queried. Characteristics of GLF and non-GLF patients were compared. Significance for categorical data was calculated with Chi Square, Student’s t-test for continuous data, and Mann-Whitney U test for ordinal data. CT negative CS injuries were identified. Binary classification tests were calculated for the ability of CT to identify CS injury using a generalized linear regression model with binomial distribution and identity link.
Results
69 (2.0%) of patients had CS injury without acute CT abnormality. Of these, 11 (0.3%) required surgery and were considered unstable. All patients who required surgery had a neurologic deficit. Negative predictive value (NPV) of CT for unstable CS injury was 99.7%. The combination of acute CT findings and neurologic deficit ruled out unstable CS injury with 100% NPV.
Conclusion
In the GLF population, CT alone rules out unstable CS injury with high, but not perfect NPV. The combination of absence of acute CT findings and acute neurologic deficits rules out unstable CS injury with 100% NPV.
No competing interests reported.
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