Helical Computed Tomography Alone Compared with Plain Radiographs with Adjunct Computed Tomography to

Background: Current literature supports the use of the three-view plain-radiograph series supplemented, when nec-essary, with helical computed tomography to evaluate the cervical spine in patients who have sustained trauma in-jury. The purpose of this study was to determine if helical computed tomography alone can be used to evaluate the cervical spine for acute osseous injury following high-energy trauma, thus eliminating the need to make radiographs. Methods: Patients were prospectively evaluated with helical computed tomography scanning of the cervical spine and standard three-view plain radiography. At a later date, the plain radiographs and computed tomography scans were in-dependently reviewed by two radiologists who were blinded to both the initial interpretation and the interpretation of the corresponding study. The radiologists documented whether the plain radiographs were adequate and whether they showed an acute process. The findings in the study were compared with the initial findings and, when necessary, with the discharge summaries to determine if an injury had been identified. The accuracy of the plain radiographs, of the plain radiographs that had been deemed adequate, and of helical computed tomography used alone was ascertained. Results: Plain radiographs and helical computed tomography scans were made for 407 patients, and traumatic inju-ries were identified in fifty-eight of them. Plain radiographs alone were adequate for 194 (48%) of the 407 patients. Plain radiographs had a sensitivity of 45%, a specificity of 97%, a positive predictive value of 74%, and a negative pre-dictive value of 91%. Adequate plain radiographs had a sensitivity of 52%, a specificity of 98%, a positive predictiv