Diagnostic Accuracy of Plain X-Ray in Diagnosis of Cervical Spine Fracture, Keeping CT as Gold Standard

Objective: Determine the diagnostic accuracy of plain x-ray in diagnosing cervical spine injury in patients of blunt trauma. Study Design: Cross sectional validation study. Place and Duration of the Study: PIMS hospital Islamabad from July- December 2015. Materials Methods: A total of 70 patients of 20-60 years of age of either gender with blunt trauma to cervical spine were included in the study. Patients with previous cervical surgery, GSC 15, hemodynamicaly unstable patients, acute paralysis, penetrating trauma, known vertebral disease (rheumatoid arthritis, ankylosing spondylitis) and pregnant females were excluded. First, all the patients underwent plain x-ray (AP Lateral views) and then computed tomographic scanning. X-ray and CT results were correlated. Results: Mean age was 36.58 ± 8.22 years. Out of 70 patients, 59 (84.29%) were males and 11 (15.71%) were females with male to female ratio of 5.3:1. Plain x-ray cervical spine supported the diagnosis of cervical spine fracture in 31 (44.29%) patients. CT has shown cervical spine fracture in 29 (41.43%) cases. The sensitivity, specificity, positive predictive value, negative predictive value and accuracy of x-ray cervical spine in diagnosing cervical spine fracture in blunt trauma patients are 89.66%, 87.80%, 83.87%, 92.31% and 88.57% respectively. Conclusion: This study concluded that x-ray cervical spine is relative low costs, widely available and low dose ionizing radiation imaging modality for immediate assessment of cervical spine in blunt trauma patients.