Test Performance of Cervical Spine Radiography as Compared to Computed Tomography in Diagnosing Traumatic Cervical Spine Injuries In adults With Head Injury at the Kenyatta National Hospital

Abstract

Background:Cervical spine injuries pose a significant challenge in resource-limited settings, particularly in Africa, due to their high mortality and morbidity rates. Different regions of the world have different approaches to evaluating cervical spine trauma in adults with head injury, with Europe using structured protocols and the United States recommending Computed Tomography as the standard screening tool. However, in Africa, there is a lack of consistent of radiological care for head injury patients, which can lead to financial burden emanating from dual imaging, missed injuries, medico-legal issues, and potentially fatal consequences including neurological deterioration and even death. It is therefore essential to determine the local sensitivity of cervical spine radiography in diagnosing cervical spine injuries in adult patients with head injury, as compared to computed tomography of the cervical spine. Objective of the Study:To establish the sensitivity of two-viewplain radiography of the cervical spine as compared to computed tomography of the cervical spine in adult patients presenting with head injury, a suspicion for traumatic cervical spine injury at the Kenyatta National Hospital. Methodology: This cross-sectional study will include 52 consecutively recruited adult participants with head injury defined by a Glasgow Coma Scale (GCS) of 14 or below. The participants will undergo 2-view plain radiography namely anteroposterior and lateral and computed tomography of the cervical spine with multiplanar reconstruction. The results will be independently interpreted and reported by two consultant radiologists. Patient demographic characteristics, mechanism of injury, sensitivity, specificity, positive and negative predictive values of 2-view cervical spine radiographs as compared to the gold standard, computed tomography of the cervical spine. Presence, type and fitness of any pre-hospital cervical spine collar will also be recorded. Measures of relative efficacy will be calculated, and statistical analyses will be conducted using the Receiver-Operating Characteristic (ROC). A desired level of confidence will be 95% and a P value of < 0.05 shall be considered to be statistically significant and categorical variables will be presented in graphs and tables. Utility of the Study:The findings from this study will provide insight into the initial radiological care of adult patients with head injury and particularly the diagnostic accuracy of 2-views plain radiography and its role in resource-limited settings, in Africa, where access to advanced imaging techniques may be limited. In addition, information from this study will facilitate the development of clinical protocols for radiological care of adults with head injury and suspected cervical spine injury, thereby potentially improving the quality of care for this high-risk patient population.