Cervical spine injury and radiography in alert, high-risk patients

Controversy exists over the need for cervical spine radiographs in alert, nonintoxicated victims of blunt trauma. We identified 286 patients admitted to a Level II trauma center over a 14-month period who were alert (Glasgow Coma Scale [GCS] greater than 13) and considered at high risk for cervical spine injury by published criteria. All 5 (1.7%) fractures or ligament disruptions occurred in the group with neck pain or tenderness. Of the study group, 141 (49%) were asymptomatic for cervical injury and nonintoxicated (blood alcohol concentration (BAC) less than 100 mg/dL). Mandatory cervical spine radiography in this group would have resulted in an additional cost of $33,699. Routine cervical spine radiography in alert, nonintoxicated asymptomatic victims of blunt trauma is a costly practice that warrants further examination.