Prospective analysis of acute cervical spine injury: a methodology to predict injury

We developed a prospective study to evaluate the clinician's ability to predict and diagnose cervical spine injury. Of 233 patients evaluated, 24 (10.4%) sustained cervical spine injury confirmed by radiography. The physician was able to predict injury with only 50% accuracy. The incidence of injury was 10.3% (24 of 233). Twenty percent (5 of 24) of cervical spine injuries would have been missed if physicians had used physical examination and mechanism of injury as criteria. Ten elements were identified as being associated statistically with cervical spine injury. Physicians cannot accurately predict the presence of cervical spine injury. Radiographs are ordered for many patients who have no evidence of injury. We used a logistic regression analysis to produce a system for predicting cervical spine injury. This methodology is easily adaptable for use in the emergency department.