High-yield roentgenographic criteria for cervical spine injuries

All trauma patients undergoing cervical radiography at an urban referral teaching hospital emergency department during 12 consecutive months were analyzed for indications and results of cervical spine radiograph studies. Demographic characteristics of the study group were consistent with results in the literature (55% men, mean age, 27). Cases were reviewed for 27 commonly accepted indications in the literature for cervical spine studies under these circumstances. The following radiograph findings were considered as positive studies: fracture, subluxation, spondylolisthesis, straightening, spasm, foreign body, compression, fusion, narrowing, or soft tissue swelling. Seventeen percent of radiographs were positive. Motor vehicle accidents (P less than .009), a history of direct cervical trauma (P less than .002), loss of consciousness (P less than .001), cervical tenderness (P less than .05), and drug ingestion (P less than .08) were associated with or suggestive of positive radiographs. No patients wearing seatbelts had positive radiographs (P less than .001). Only 2.4% (18 of 749) of radiographic examinations revealed clinically significant findings, and no criteria were statistically correlated with clinically significant findings. While our study suggests up to two-thirds of radiographs might be deferred without missing a clinically significant injury using these high-yield criteria, a flexible approach to cervical roentgenographs is justified pending confirmation of our results by a large, multicenter, prospective study currently under way.