Clinical indications for cervical spine radiographs in alert trauma patients

Cervical spine fracture/dislocation is a potentially devastating injury that may be clinically difficult to diagnose. Therefore, a vast majority of trauma patients undergo cervical spine X rays when only a relatively small number of them will actually have a cervical spine injury. Because of the costly overuse of radiography, studies have been undertaken to define high yield criteria for evaluation of patients. This study examined the characteristics of acute cervical spine fracture/dislocation in alert trauma patients. Of 79 patients with this discharge diagnosis at St. Elizabeth Hospital Medical Center between 1982 and 1987, 47 met the criteria of Class I level of consciousness. All 47 patients complained of neck pain or demonstrated cervical tenderness to palpation. Other parameters (such as loss of consciousness, paresthesias, decreased sensation, weakness, cervical muscle spasm, decreased anal tone, and associated injuries) did not, individually or in combination with each other, consistently predict cervical spine injury. Although occult or painless cervical spine injuries have been reported in the literature, a careful review of these cases revealed that these injuries were not truly asymptomatic. Our study suggests that selected patients can be excluded from radiologic evaluation of the cervical spine. However, large prospective studies are needed to validate this finding.