Difference between revisions of "Template:Neck trauma - choice of modality"

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==={{#ifeq: {{PAGENAME}} |Trauma| Neck (cervical spine) | Choice of modality }}===
 
==={{#ifeq: {{PAGENAME}} |Trauma| Neck (cervical spine) | Choice of modality }}===
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In neck trauma, a normal clinical evaluation may clear the neck without diagnostic imaging, such as using the the Canadian C-spine rule.<ref name="SaragiottoMaher2018">{{cite journal|last1=Saragiotto|first1=Bruno T|last2=Maher|first2=Christopher G|last3=Lin|first3=Chung-Wei Christine|last4=Verhagen|first4=Arianne P|last5=Goergen|first5=Stacy|last6=Michaleff|first6=Zoe A|title=Canadian C-spine rule and the National Emergency X-Radiography Utilization Study (NEXUS) for detecting clinically important cervical spine injury following blunt trauma|journal=Cochrane Database of Systematic Reviews|year=2018|issn=14651858|doi=10.1002/14651858.CD012989}}</ref> When imaging is indicated, recommendations differ somewhat between children and adults:
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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<ref name=UpToDateChildren>{{cite web|url=https://www.uptodate.com/contents/evaluation-and-acute-management-of-cervical-spine-injuries-in-children-and-adolescents|title=Evaluation and acute management of cervical spine injuries in children and adolescents|author=Julie C Leonard|date=2018-02-12|website=UpToDate}}</ref> and UK<ref name=NICE>{{cite web|url=https://www.nice.org.uk/guidance/CG176|title=Head injury: assessment and early management|date=2014|website=National Institute for Health and Care Excellence (NICE)}} Updated in June 2017</ref> guidelines. Swedish guidelines recommend CT rather than X-ray in all children over the age of 5.<ref>{{cite web|url=https://vardgivare.skane.se/vardriktlinjer/medicinska-omraden/akutsjukvard/vardprogram-riktlinjer/traumamanual/#Nackskada|website=Region Skåne|title=Traumamanual}} Last updated: 2018-03-29</ref> It is thus reasonable to indicate CT by a combination of higher severity and older age.
 
*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<ref name=UpToDateChildren>{{cite web|url=https://www.uptodate.com/contents/evaluation-and-acute-management-of-cervical-spine-injuries-in-children-and-adolescents|title=Evaluation and acute management of cervical spine injuries in children and adolescents|author=Julie C Leonard|date=2018-02-12|website=UpToDate}}</ref> and UK<ref name=NICE>{{cite web|url=https://www.nice.org.uk/guidance/CG176|title=Head injury: assessment and early management|date=2014|website=National Institute for Health and Care Excellence (NICE)}} Updated in June 2017</ref> guidelines. Swedish guidelines recommend CT rather than X-ray in all children over the age of 5.<ref>{{cite web|url=https://vardgivare.skane.se/vardriktlinjer/medicinska-omraden/akutsjukvard/vardprogram-riktlinjer/traumamanual/#Nackskada|website=Region Skåne|title=Traumamanual}} Last updated: 2018-03-29</ref> 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.<ref name=NICE/> 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.<ref>{{cite web|url=https://www.uptodate.com/contents/evaluation-and-acute-management-of-cervical-spinal-column-injuries-in-adults|title=Evaluation and acute management of cervical spinal column injuries in adults|date=2018-05-24|author=Amy Kaji, Robert S Hockberger}}</ref>
 
*In '''adults''', UK guidelines are largely similar as in children.<ref name=NICE/> 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.<ref>{{cite web|url=https://www.uptodate.com/contents/evaluation-and-acute-management-of-cervical-spinal-column-injuries-in-adults|title=Evaluation and acute management of cervical spinal column injuries in adults|date=2018-05-24|author=Amy Kaji, Robert S Hockberger}}</ref>

Revision as of 16:15, 7 May 2019

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[1] and UK[2] guidelines. Swedish guidelines recommend CT rather than X-ray in all children over the age of 5.[3] 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.[2] 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.[4]

References

  1. ↑ Julie C Leonard (2018-02-12). Evaluation and acute management of cervical spine injuries in children and adolescents. UpToDate.
  2. ↑ 2.0 2.1 . Head injury: assessment and early management. National Institute for Health and Care Excellence (NICE) (2014). Updated in June 2017
  3. ↑ . Traumamanual. Region Skåne. Last updated: 2018-03-29
  4. ↑ Amy Kaji, Robert S Hockberger (2018-05-24). Evaluation and acute management of cervical spinal column injuries in adults.
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