Is imaging the spine enough? Characterizing outcomes in injured patients who underwent computed tomography (CT) of the thoracic or lumbar spine.

INTRODUCTION

Choosing which patients should undergo computed tomography (CT) and what specific studies they should undergo remains an important decision point in caring for traumatically injured patients. Patients with physical exam findings isolated to the thoracic and/ or lumbar (T/L) spine may undergo CT T/L spine or CT of the chest, abdomen, and/ or pelvis (C/A/P), with clinicians alternately choosing between approaches based on perceived risks and benefits related to radiation, cost, and diagnostic value. No prior study has evaluated the outcomes of patients who underwent CT T/L spine to assess the risks and benefits of this more limited approach.

METHODS

We performed a retrospective cohort study of patients admitted to a large urban level 1 trauma center from January 1, 2021 to December 31, 2024 who underwent CT T/L spine. We collated data using information collected through our trauma registry as well as data gathered through manual chart review. We generated descriptive data related to patient, intervention, and imaging-related characteristics.

RESULTS

During the study period, 127 patients were admitted following a traumatic injury and underwent CT T/L spine. The imaging studies obtained and their chronologies differed among included patients. Of 58 patients who underwent initial CT T/L spine, 13 (22%) had evolving circumstances prompting additional CT C/A/P. Of these, two had new injuries identified on CT C/A/P. Those patients who first underwent CT T/L spine and then underwent CT C/A/P were administered an additional median of 547 milliGray x centimeters in the second set of images. Patients from all imaging chronology groups had discrepancies between documented physical exam and imaging findings.

DISCUSSION: A substantial number of patients who underwent CT T/L spine developed additional circumstances prompting a repeat set of images with CT C/A/P, with a small number of patients having additional clinically relevant injuries identified at that time. Upfront imaging with CT C/A/P might reduce the need for multiple trips to the CT scanner with an associated impact on labor needs, cost, and administered radiation.