Cervical radiographic evaluation of alert patients following blunt trauma

The records of 333 consecutive alert patients admitted to a trauma service for neurologic observation after sustaining significant blunt head trauma were reviewed. All patients had class I level of consciousness (alert, responds immediately to questions, may be disoriented and confused, follows complex commands); those with significant acute alcohol and/or drug intoxication were excluded from this study. Cervical spine injury did not correlate with the presence of major concomitant injuries, skull fractures, or major intracranial injuries. Cervical spine injury correlated only with the presence of signs and/or symptoms of cervical injury. This correlation was highly significant (P less than .05). Five of the 42 patients (11%) with signs and/or symptoms of cervical injury had cervical spine fractures. No patient without signs and/or symptoms of cervical injury had a cervical spine injury. These findings suggest that among alert patients with class I level of consciousness who have sustained blunt injury, only those who present with signs and/or symptoms of cervical injury require cervical radiographic evaluation.