Determining the need for stabilising therapy
of cervical spine injuries on CT: towards
standardising decision-making in the
emergency department

Determining the need for stabilising therapy
of cervical spine injuries on CT: towards
standardising decision-making in the
emergency department

Cervical vertebrae, Spinal injuries, Tomography, spiral computed, Therapeutics, Classification.

Abstract
Background In clinical practice, currently no standardised approach exists to determine which patients with cervical
spine injury (CSI) on CT scan should receive continued cervical spine immobilisation and a neurosurgeon is generally
consulted. Insights into the contribution of CT assessment and classification of CSI in determining the need for
stabilising therapy could aid in standardising clinical practice in the emergency department. Standardising clinical
practice for cervical spine immobilisation could potentially improve the patient flow in the emergency department
by reducing delay in decision-making, particularly in hospitals without availability of immediate neurosurgical
consultation. Therefore the aim of this study was to investigate if CT assessment and classification of CSI, without
clinical information, can determine whether a patients’ injury is an injury in need of stabilising therapy (IST).
Methods In this observational, retrospective study, a database with a multidisciplinary, extensively validated
reference standard was used. Consecutive patients screened for CSI using CT (2007-2014) in a level-one trauma
centre in the Netherlands were included. Actual therapy that has been provided was compared to the assessment
of CSI by three neurosurgeons on CT for presence of ISTs. Clinical information was not provided during initial CT
assessment. Injury types were classified according to the AOSpine Injury Classification System. Concordance rates of
CT assessment by the neurosurgeons compared to actual therapy provided for presence of ISTs with 95% confidence
intervals (95% CI) were calculated.
Results Of the 273 patients in the database with a CSI, 262 were included. CT assessment of CSIs led to assignment
as IST in 155/262 cases (59.2%). Based on the actual therapy provided, 124/262 cases (47.3%) were an IST. CT

Brigitta Y. M. van der Kolk1,2,3*†, Gaby J. van den Wittenboer1,2*†, Ingrid M. Nijholt2

, Martin Podlogar4
,

Wimar A. van den Brink4

, Gerrit Joan Bouma5

, Lonneke N. Buijteweg1

, Boudewijn A. A. M. van Hasselt2
,

Niels W. L. Schep6

, Mario Maas3,7 and Martijn F. Boomsma2

2025

Peri Irawan

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