Outcomes at 12 months after early magnetic resonance imaging in acute trauma patients with persistent midline cervical tenderness and negative computed tomography

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Abstract

A prospective observational cohort study of alert, neurologically intact trauma patients presenting to the emergency department with midline cervical tenderness. Screening cervical magnetic resonance imaging (MRI) had been conducted after negative computed tomography (CT) when tenderness was persistent. Objective. To determine the association of acute fi ndings and demographic characteristics with any long-term neck disability, and with time to return to work in such patients. Summary of Background Data. The relationship between acute fi ndings and outcomes in these patients is unknown, and we hypothesized that outcomes at 12 months would correlate with acute clinical signs and symptoms, MRI fi ndings, and mechanisms of injury. Methods. Patients at a Level 1 trauma center with persistent midline cervical tenderness in the absence of evidence of intoxication, painful distracting injury, persistently abnormal neurology, or acute CT fi ndings, who underwent early cervical MRI under the institutional protocol, were reviewed in the outpatient spine clinic after discharge. In addition, the factors associated with neck disability and time to return to work were examined at followup at 12 months after presentation. Results. There were 162 of 178 patients available for follow-up at 12 months (91 ). Of these, 46 had MRI-identifi ed cervical spine injury at their initial examination, and 22 had required clinical management, including 2.5 with operative stabilization. Neck disability was present in 43 of patients and was associated with depressive symptoms, workers? compensation, and low annual income. Delay in return to work was associated with the presence of minor limb/other fractures and depressive symptoms, whereas patients on high annual incomes were found to return to work more quickly. Conclusion. Surprisingly in these acute trauma patients, MRIdetected injury, clinical factors, and injury mechanism were not found to be a
Original languageEnglish
Pages (from-to)1068 - 1081
Number of pages14
JournalSpine
Volume38
Issue number13
DOIs
Publication statusPublished - 2013

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