Screening cervical spine CT in a level I trauma center: overutilization?

Area of Science:

• Radiology
• Emergency Medicine
• Trauma Care

Background:

• Cervical spine CT scans are frequently used for trauma patients.
• The National Emergency X-Radiography Utilization Study (NEXUS) established low-risk criteria to identify patients unlikely to have a cervical spine injury.

Purpose of the Study:

• To analyze the utilization of screening cervical spine CT scans in trauma patients.
• To determine the potential for avoiding unnecessary CT scans by applying evidence-based clinical criteria.

Main Methods:

• Retrospective analysis of 1589 cervical spine CT examinations in adult trauma patients.
• Review of radiology reports and clinical data for injuries and documented NEXUS low-risk criteria (posterior midline cervical tenderness, focal neurologic deficit, altered level of alertness, intoxication, distracting injury).

Main Results:

• Only 2.6% of CT scans revealed acute cervical spine injury.
• 23.9% of negative scans lacked documentation of any NEXUS low-risk criteria.
• A significant portion of screening CTs may be avoidable.

Conclusions:

• Strict application of NEXUS low-risk criteria could reduce cervical spine CT examinations by over 20%.
• Implementing these criteria can decrease unnecessary radiation exposure and healthcare costs.