Where do we go after the three standard cervical spine views in the conscious trauma patient? A survey

The objective of this study was to assess, by questionnaire survey, national practice in respect of radiological assessment of the cervical spine in the conscious adult patient with suspected neck injury. The physicians in charge of accident and emergency departments with more than 25000 new patients per year were sent a questionnaire. One hundred and ninety-one replies were received from 243 physicians (79%). Sixty-five per cent of departments have written protocols for imaging the cervical spine. Seven per cent of departments use fewer than the three standard views for clearing the cervical spine. If adequate views do not visualize the cervicothoracic junction, 89% use swimmer's views and 12% use supine oblique views, prior to computerized tomography scanning. It is concluded that the majority of departments use three standard views in the first instance. Swimmer's views are the most common additional X-rays taken if the C7-T1 junction is not visualized, even though supine oblique views give better information about spinal alignment. Imaging of the cervical spine following trauma is difficult and guidelines should be drawn up to address these problems.