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Invited Commentary |

Is Any Test 100% Specific and 100% Sensitive for Serious Injury?

Martin A. Schreiber, MD1
[+] Author Affiliations
1Department of Surgery, Oregon Health & Science University, Portland
JAMA Surg. 2014;149(9):940. doi:10.1001/jamasurg.2014.880.
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Resnick and colleagues1 have performed a prospective observational trial during a 17-month period assessing the accuracy of cervical spine computed tomography (CT) in the evaluation of patients with blunt trauma. The population included patients at a level I trauma center with persistent cervical tenderness or a focal neurologic deficit. They have also evaluated the usefulness of performing magnetic resonance imaging (MRI) in these patients. The authors boldly conclude that advanced generational CT scanning is 100% sensitive and 100% specific in detecting significant cervical spine injuries and that MRI is of no use except maybe in patients with focal motor deficits. None of the patients evaluated in this study had focal motor deficits. This is a very important study because it suggests that MRI is not needed in this patient population, which significantly simplifies their care. However, several issues need to be considered before accepting the authors’ conclusions at face value.

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