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Protocol-driven radiologic evaluation of suspected cervical spine injury: efficacy study
S E Mirvis1, J N Diaconis, P A Chirico
1Department of Diagnostic Radiology, University of Maryland Medical System/Hospital, Baltimore 21201.
Radiology
|March 1, 1989
Summary
Routine cervical spine imaging for major blunt trauma patients is costly and may not be clinically effective. A study found that careful bedside assessment is valuable for alert, asymptomatic patients, questioning the need for universal imaging.
Area of Science:
- Trauma Surgery
- Radiology
- Emergency Medicine
Background:
- The American College of Surgery recommends routine cervical radiography for major blunt trauma.
- A survey indicated 96% of North American trauma centers follow this protocol.
- The cost-benefit of this practice remains largely unexamined.
Purpose of the Study:
- To evaluate the cost-effectiveness of routine cervical spine imaging in major blunt trauma.
- To compare clinical assessment with radiographic and CT outcomes in asymptomatic patients.
Main Methods:
- A prospective study of 408 major blunt trauma patients over 19 months.
- Comparison of bedside clinical assessment with cervical radiography and CT scans.
- Analysis of imaging results in 138 mentally alert, asymptomatic patients.
Main Results:
- Only one C-7 transverse process fracture was detected in asymptomatic patients (prevalence <1%).
- Cervical radiography and CT for 138 asymptomatic patients cost $59,202.
- Bedside clinical assessment identified no significant injuries in this cohort.
Conclusions:
- Routine cervical spine imaging in all major blunt trauma patients is of questionable cost and clinical efficacy.
- Careful bedside clinical assessment is valuable for alert, asymptomatic blunt trauma victims.
- The study supports a more selective approach to cervical spine imaging in trauma care.