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Flexion and extension views are not cost-effective in a cervical spine clearance protocol for obtunded trauma
Jeff Anglen1, Michael Metzler, Paul Bunn
1Department of Orthopaedic Surgery, University of Missouri, Columbia, Missouri 65212, USA.
Background:
Between 1994 and 1999, 837 flexion-extension cervical spine films (F/E) were ordered as part of a protocol to evaluate cervical stability in blunt trauma victims, particularly obtunded patients with otherwise normal films. After 5 years' experience with this protocol, a review of its efficiency and cost-effectiveness was performed.
Method:
The radiology reports and charts were reviewed for positive or suggestive F/E series.
Results:
Nearly a third of all series were inadequate to rule out instability. Only four patients were identified who had decreased admission Glasgow Coma Scale score, normal plain films and/or CT, and positive or suggestive findings on F/E. One was felt to be a false positive, and the others had minor or borderline findings; all were treated with continuation of the cervical collar. Although one patient was lost to follow-up, none of the other three required subsequent surgery or developed deformity or neurologic injury.
Conclusion:
Flexion-extension studies were not a cost-effective part of the protocol, and they were dropped.
