Neck trauma

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Author: Mikael Häggström [notes 1]

Military neck trauma simulation.jpg

Planning

Indication for imaging

In neck trauma, a normal clinical evaluation may clear the neck without diagnostic imaging, such as using the the Canadian C-spine rule.[1] In practice, there is rarely any reason for a radiologist to decline an imaging request from a clinician for a trauma patient.

How soon

Generally within a couple of hours.

Choice of modality

Recommendations differ somewhat between children and adults:

  • In children, CT of the neck in trauma is indicated in more severe cases such as neurologic deficits, whereas X-ray of the cervical spine is preferable in milder cases, by both US[2] and UK[3] guidelines. Swedish guidelines recommend CT rather than X-ray in all children over the age of 5.[4] It is thus reasonable to indicate CT by a combination of higher severity and older age.
  • In adults, UK guidelines are largely similar as in children.[3] US guidelines, on the other hand, recommend CT of the neck in trauma in all cases where medical imaging is indicated, and that X-ray of the cervical spine is only acceptable where CT is not readily available.[5]

Notes

  1. For a full list of contributors, see article history. Creators of images are attributed at the image description pages, seen by clicking on the images. See Radlines:Authorship for details.

References

  1. Saragiotto, Bruno T; Maher, Christopher G; Lin, Chung-Wei Christine; Verhagen, Arianne P; Goergen, Stacy; Michaleff, Zoe A (2018). "Canadian C-spine rule and the National Emergency X-Radiography Utilization Study (NEXUS) for detecting clinically important cervical spine injury following blunt trauma ". Cochrane Database of Systematic Reviews. doi:10.1002/14651858.CD012989. ISSN 14651858. 
  2. Julie C Leonard (2018-02-12). Evaluation and acute management of cervical spine injuries in children and adolescents. UpToDate.
  3. 3.0 3.1 . Head injury: assessment and early management. National Institute for Health and Care Excellence (NICE) (2014). Updated in June 2017
  4. . Traumamanual. Region Skåne. Last updated: 2018-03-29
  5. Amy Kaji, Robert S Hockberger (2018-05-24). Evaluation and acute management of cervical spinal column injuries in adults.