Keywords: Spine fracture, decision rule (PubMed Search)
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%)
Clavicle fracture (18%)
Scapular fracture (17%)
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.
Bizimungu R, Sergio Alvarez, Baumann BM, et al. Thoracic Spine Fracture in the Panscan Era. Ann Emerg Med. 2020;76(2):143-148.