UMEM Educational Pearls

Category: Orthopedics

Title: Thoracic Spine Fractures in the Panscan Era

Keywords: Spine fracture, decision rule (PubMed Search)

Posted: 9/12/2020 by Brian Corwell, MD (Updated: 10/24/2020)
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A recent study looked at thoracic spinal fractures in the era of the trauma panscan

NEXUS Chest CT Study from 2011 to 2014 at 9 Level I trauma centers.

Goal: To describe the identification rate and types of thoracic spine fractures.

Inclusion: age over 14 years, blunt trauma occurring within 6 hours of ED presentation, and chest CT imaging during ED evaluation.

11,477 subjects, 217 (1.9%) had a thoracic spine fracture

The majority of spine fractures in patients who had both chest x-ray and CT were observed on CT only (91%). 50% had more than 1 thoracic spinal level involved (mean 2.1). 22% had associated cervical fractures and 25% had associated lumbar fractures.

               64% had vertebral body fractures

               45% had posterior column fractures

               28% had compression fractures

               6% had burst fractures

Many patients (62%) had associated thoracic injuries such as

               Rib fractures (45%)

               PTX (36%)

               Clavicle fracture (18%)

               Scapular fracture (17%)

               Hemothorax (15%)

 

100 patients had clinically significant thoracic spine fractures.

 

Thoracic spine fractures are relatively uncommon in adult patients with blunt trauma.

If thoracic spine fracture is suspected clinically, radiography is not an effective screen and clinician should consider CT. If not suspected, guidelines discourage ordering CT to screen for this injury because of effective screening instruments, the diagnosis of clinically insignificant injuries and radiation exposure.

All clinically significant thoracic spine fractures would have been detected by the NEXUS Chest CT decision instrument.

 

https://www.mdcalc.com/nexus-chest-ct-decision-instrument-ct-imaging

 

References

Bizimungu R, Sergio Alvarez, Baumann BM, et al. Thoracic Spine Fracture in the Panscan Era. Ann Emerg Med. 2020;76(2):143-148.