Role of routine emergency cervical radiography in head trauma

This review of 406 patients with head injury examines the role of emergency cervical radiography in head trauma and the frequency of associated cervical spine injury. Of 293 patients who had emergency cervical radiography (72 percent), 8 showed some abnormality, but only 5 (1.2 percent) were significant for cervical spine injury. All eight patients were, however, clinically suspected to have associated cervical spine injury before emergency cervical radiography. One hundred thirteen patients (28 percent) did not undergo emergency cervical radiography based on clinical evaluation, and none was subsequently found to have a missed cervical spine injury. There was no correlation between severity of head injury and the presence of associated cervical spine injury (p greater than 0.16). Head trauma is infrequently associated with cervical spine injury and when present is usually not clinically occult. Emergency cervical radiography is not efficacious and should not be routine in the emergency room management of head trauma. When associated cervical spine injury is clinically suspected, adequate cervical immobilization should be maintained and cervical radiography performed on a low priority basis. Head injury due to automobile and pedestrian or motorcycle and automobile accident may be more likely to be associated with cervical spine injury.