Rational ordering of cervical spine radiographs following trauma

Area of Science:

• Emergency Medicine
• Orthopedic Surgery
• Radiology

Background:

• Cervical spine injuries require prompt and accurate diagnosis to prevent neurological deficits.
• Emergency department (ED) evaluation of trauma patients often relies on presenting signs and symptoms.

Purpose of the Study:

• To identify presenting signs, symptoms, and coexisting conditions in patients with cervical spine injuries.
• To determine the rate of missed cervical spine injuries in the ED.
• To propose an improved diagnostic strategy for cervical spine injuries.

Main Methods:

• Retrospective review of 312 hospitalized patients with cervical spine injuries.
• Analysis of presenting signs, symptoms, coexisting conditions, and diagnostic accuracy in the ED.
• Review of radiographic findings and reasons for missed diagnoses.

Main Results:

• Of 257 alert patients, 84% reported neck pain; however, 34 alert patients without neck pain had signs suggestive of injury.
• 23 of 284 patients presenting within 48 hours had injuries initially missed, primarily due to negative radiographs or no radiographs taken.
• Multiple spinal column fractures were common in this patient cohort.

Conclusions:

• Neck pain is a common but not universal symptom in cervical spine injuries, necessitating a thorough evaluation even in its absence.
• Diagnostic errors in the ED can occur due to interpretation of radiographs or failure to obtain them.
• A stepwise approach to ordering cervical spine radiographs in blunt trauma is recommended to enhance diagnostic accuracy.