Diagnostic Value of Bedside Ultrasound for Detecting Cervical Spine Injuries in Patients with Severe Multiple Trauma

Abstract

The study aimed to assess the diagnostic value of bedside ultrasound in the cervical spine to detect cervical spine injuries in patients with severe multiple trauma. Material and Methods: A cross-sectional analytic study was conducted on 172 trauma patients with severe multiple trauma. Patients with Glasgow Coma Scale (GCS) less than 12 or triage revised trauma score (TRTS) less than 8 was considered to have "Severe trauma". The researcher performed bedside diagnostic ultrasound examination, without impeding the ongoing routine management of patients. The researcher was blind to the CT scan findings until the end of study. The collected data were analyzed in SPSS 22.0. Sensitivity and specificity, positive and negative predictive value, positive and negative likelihood ratio (LR) of ultrasound were compared with CT scan in detecting cervical spine injuries. Also, the results were compared for children (<14y) and adult (>14y) age groups. In all cases, P values less than 0.05 was considered as significant. Result: Bedside ultrasonography (US) had sensitivity of 74.5%, specificity of 97.6%, positive predictive value (PPV) of 92.1%, negative predictive value (NPV) of 91%, and accuracy of 91.3% in detecting spinal injuries in comparison with CT scan as gold standard modality. Bedside US had sensitivity of 100%, specificity of 87.6, PPV of 50%, NPV of 100%, and accuracy of 88.9% in detecting spinal injuries with movement of fractured or dislocated particles. The modality had sensitivity of 33.3%, specificity of 87.58, PPV of 100%, NPV of 97.2%, and accuracy of 97.2% in ≤14 years multi trauma patients. The modality had sensitivity of 76.2%, specificity of 94.7, PPV of 91.4%, NPV of 84.4%, and accuracy of 86.9% in >14 years multi trauma patients.