Compliance With NICE Guidance for Cervical Spine Trauma Imaging: A Single Centre Retrospective Evaluation

In 2016 the National Institute for Health and Care Excellence (NICE) published guidance in England recommending computed tomography (CT) as the first line imaging for cervical spine (C-spine) injury in adults. However anecdotal evidence suggests that X-rays are still being performed. The aim of this evaluation was to determine the imaging referral patterns following C-spine trauma and compare with national guidance.

Within a single English organisation emergency department patient attendance data, X-ray and CT referral criteria and acquisition information for patients ≥ 16 years undergoing imaging of the C-spine was collated from a 12-month period (01.01.23-31.12.23).

The cohort contained 302 females and 301 males, with a median age of 55 years. According to the clinical information 12.1% (n = 73/603) of the patients had no risk of C-spine injury and therefore should not have required diagnostic imaging. Almost two thirds of patients (n = 395/603; 65.5%) had first line CT imaging consistent with national guidance. Of those where imaging was justified, 135 patients had the incorrect initial diagnostic test (X-ray as opposed to CT) with 26 also having a subsequent CT. The quality of all of the X-rays were reviewed and only 39.5% (n = 73/185) of cases were diagnostic.

In 2023, the organisation was 65.5% compliant with the guidance, with a number of patients referred for unjustified imaging examinations and/or the wrong initial imaging modality. The consequences of this included treatment delays, prolonged immobilisation, over-irradiation and impact upon resources, along with potentially missed pathology due to inconclusive X-rays.