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Exclusion of unstable cervical spine injury in obtunded patients with blunt trauma: Is MR imaging needed when multi-detector row CT findings are normal?
The Journal of Emergency Medicine, Vol. 31, No. 1, pp. 123–127, 2006 Copyright © 2006 Elsevier Inc. Printed in the USA. All rights reserved 0736-4679/06 $–see front matter
doi:10.1016/j.jemermed.2006.03.018
Abstracts e COCAINE AND CORONARY CALCIFICATION IN YOUNG ADULTS. THE CORONARY ARTERY RISK DEVELOPMENT IN YOUNG ADULTS (CARDIA) STUDY. Pletcher MJ, Kiefe DI, Sidney S, et al. Am Heart J 2005;150:921– 6. This study examined the correlation between cocaine use and coronary calcification in participants enrolled in a longitudinal study of risk factors for coronary artery disease. At the 15-year evaluation of the CARDIA cohort, 3038 participants answered questions about cocaine use and underwent computed tomography (CT) to quantify coronary artery calcification. Before adjustment for age, sex, socioeconomic status, ethnicity, family history, smoking and alcohol use, cocaine exposure was strongly associated with coronary calcification. After adjustment for these factors, however, the correlation disappeared, with adjusted odds ratios for coronary calcification of 0.9 (95% confidence intervals [CI] 0.6 – 1.3) for 1 to 10 lifetime episodes, 1.2 (95% CI 0.8 –1.7) for 11–99 episodes and 1.0 (95% CI 0.6 –1.6) for ⱖ 100 lifetime episodes of cocaine exposure. Male gender, alcohol and tobacco use were the three most important confounders, whereas systolic blood pressure, LCL-C, and HCL-C remained strong independent predictors of coronary calcification. The authors conclude that the increased rate of myocardial ischemia and infarction seen in cocaine users is due primarily to the acute effects of cocaine rather than accelerated atherogenesis. [Mary Westergaard, MD Denver Health Medical Center, Denver, CO]
aging of the cervical spine in blunt trauma patients with unreliable examinations and normal computed tomography (CT) findings. Data were collected for 366 obtunded patients with normal cervical spine CT results who had MR studies done to exclude soft tissue injury. All abnormal MR reports were collected and the associated CT and MR images were subsequently reviewed by separate senior attending trauma radiologists. Twelve of the 366 patients were found to have evidence of acute cervical spine injury on MR, including seven patients with cord contusion, four patients with ligamentous injury, three patients with intervertebral disk edema, and one patient with cord contusion, ligamentous injury and intervertebral disk edema. The negative predictive value for multi-detector row CT was 98.9% for ligamentous injury and 100% for unstable cervical spine injury (damage involving two adjacent ligament support columns). The authors propose a blunt trauma cervical spine protocol for obtunded patients, which includes CT imaging of the entire cervical spine without need for MR or dynamic fluoroscopy if results are normal. [Mary Westergaard, MD Denver Health Medical Center, Denver, CO] Comment: Although prospective confirmation is needed, this study demonstrates that today’s CT scanners are capable of detecting most if not all serious cervical spine injuries in blunt trauma victims. The study findings support a reasonable and rational solution to the problem of “clearing” the cervical spine of the obtunded trauma patient.
Comment: This longitudinal study provides unique insight into the causes of coronary disease in people who use cocaine. Accelerated coronary calcification does not seem to be the mechanism for increased risk of myocardial ischemia and infarction; however, other chronic coronary changes (such as non-calcified lesions) could still be contributory.
e RESCUE ANGIOPLASTY AFTER FAILED THROMBOLYTIC THERAPY FOR ACUTE MYOCARDIAL INFARCTION. Gershlick AH, Stephens-Lloyd A, Hughes S, et al. N Engl J Med 2005;353:2758 – 68. This multicenter trial from the United Kingdom identified 427 patients with ST-segment elevation myocardial infarction who failed to achieve reperfusion (defined as 50% ST segment resolution) within 90 min after thrombolytic therapy. The patients were randomized to receive rescue percutaneous coronary intervention (PCI), repeat thrombolysis or conservative medical treatment, and the primary composite endpoint of death, reinfarction, stroke or severe heart failure within 6 months was measured. Although there was no statistically
e EXCLUSION OF UNSTABLE CERVICAL SPINE INJURY IN OBTUNDED PATIENTS WITH BLUNT TRAUMA: IS MR IMAGING NEEDED WHEN MULTI-DETECTOR ROW CT FINDINGS ARE NORMAL? Hogan GJ, Mirvis SE, Shanmuganathan K, et al. Radiology 2005;237: 106 –13. This retrospective study analyzed what additional information is gained from performing magnetic resonance (MR) im-
Abstracts are coordinated by Jason S. Haukoos, MD, MS, of Denver Health Medical Center, Denver, Colorado. Abstracts are prepared by the Emergency Medicine Residents of the Denver Affiliated Residency in Emergency Medicine, Denver, Colorado. 123
doi:10.1016/j.jemermed.2006.03.018
Abstracts e COCAINE AND CORONARY CALCIFICATION IN YOUNG ADULTS. THE CORONARY ARTERY RISK DEVELOPMENT IN YOUNG ADULTS (CARDIA) STUDY. Pletcher MJ, Kiefe DI, Sidney S, et al. Am Heart J 2005;150:921– 6. This study examined the correlation between cocaine use and coronary calcification in participants enrolled in a longitudinal study of risk factors for coronary artery disease. At the 15-year evaluation of the CARDIA cohort, 3038 participants answered questions about cocaine use and underwent computed tomography (CT) to quantify coronary artery calcification. Before adjustment for age, sex, socioeconomic status, ethnicity, family history, smoking and alcohol use, cocaine exposure was strongly associated with coronary calcification. After adjustment for these factors, however, the correlation disappeared, with adjusted odds ratios for coronary calcification of 0.9 (95% confidence intervals [CI] 0.6 – 1.3) for 1 to 10 lifetime episodes, 1.2 (95% CI 0.8 –1.7) for 11–99 episodes and 1.0 (95% CI 0.6 –1.6) for ⱖ 100 lifetime episodes of cocaine exposure. Male gender, alcohol and tobacco use were the three most important confounders, whereas systolic blood pressure, LCL-C, and HCL-C remained strong independent predictors of coronary calcification. The authors conclude that the increased rate of myocardial ischemia and infarction seen in cocaine users is due primarily to the acute effects of cocaine rather than accelerated atherogenesis. [Mary Westergaard, MD Denver Health Medical Center, Denver, CO]
aging of the cervical spine in blunt trauma patients with unreliable examinations and normal computed tomography (CT) findings. Data were collected for 366 obtunded patients with normal cervical spine CT results who had MR studies done to exclude soft tissue injury. All abnormal MR reports were collected and the associated CT and MR images were subsequently reviewed by separate senior attending trauma radiologists. Twelve of the 366 patients were found to have evidence of acute cervical spine injury on MR, including seven patients with cord contusion, four patients with ligamentous injury, three patients with intervertebral disk edema, and one patient with cord contusion, ligamentous injury and intervertebral disk edema. The negative predictive value for multi-detector row CT was 98.9% for ligamentous injury and 100% for unstable cervical spine injury (damage involving two adjacent ligament support columns). The authors propose a blunt trauma cervical spine protocol for obtunded patients, which includes CT imaging of the entire cervical spine without need for MR or dynamic fluoroscopy if results are normal. [Mary Westergaard, MD Denver Health Medical Center, Denver, CO] Comment: Although prospective confirmation is needed, this study demonstrates that today’s CT scanners are capable of detecting most if not all serious cervical spine injuries in blunt trauma victims. The study findings support a reasonable and rational solution to the problem of “clearing” the cervical spine of the obtunded trauma patient.
Comment: This longitudinal study provides unique insight into the causes of coronary disease in people who use cocaine. Accelerated coronary calcification does not seem to be the mechanism for increased risk of myocardial ischemia and infarction; however, other chronic coronary changes (such as non-calcified lesions) could still be contributory.
e RESCUE ANGIOPLASTY AFTER FAILED THROMBOLYTIC THERAPY FOR ACUTE MYOCARDIAL INFARCTION. Gershlick AH, Stephens-Lloyd A, Hughes S, et al. N Engl J Med 2005;353:2758 – 68. This multicenter trial from the United Kingdom identified 427 patients with ST-segment elevation myocardial infarction who failed to achieve reperfusion (defined as 50% ST segment resolution) within 90 min after thrombolytic therapy. The patients were randomized to receive rescue percutaneous coronary intervention (PCI), repeat thrombolysis or conservative medical treatment, and the primary composite endpoint of death, reinfarction, stroke or severe heart failure within 6 months was measured. Although there was no statistically
e EXCLUSION OF UNSTABLE CERVICAL SPINE INJURY IN OBTUNDED PATIENTS WITH BLUNT TRAUMA: IS MR IMAGING NEEDED WHEN MULTI-DETECTOR ROW CT FINDINGS ARE NORMAL? Hogan GJ, Mirvis SE, Shanmuganathan K, et al. Radiology 2005;237: 106 –13. This retrospective study analyzed what additional information is gained from performing magnetic resonance (MR) im-
Abstracts are coordinated by Jason S. Haukoos, MD, MS, of Denver Health Medical Center, Denver, Colorado. Abstracts are prepared by the Emergency Medicine Residents of the Denver Affiliated Residency in Emergency Medicine, Denver, Colorado. 123