The effect of introducing guidelines for cervical spine radiographs in the accident and emergency department

To assess the effect of guidelines for x ray requests on requests for cervical spine x rays.

Accident and emergency (A&E) department of tertiary referral centre.

Guidelines for all x ray requests were introduced in the (A&E) department of the Royal Infirmary of Edinburgh in February 1992. The effect of the guidelines on requests for cervical spine x rays was assessed by retrospective review of all such x rays taken over two 30 d periods, before and after the introduction of the guidelines. Junior staff had been in post for 3 months during both periods assessed. Films were reviewed for quality by a consultant radiologist.

Guidelines reduced the number of inappropriate requests significantly; however, 26% of requests were still unnecessary. The standard of radiography improved but 49% of x rays remained inadequate, usually because the C7/T1 level was not demonstrated on the lateral view. The A&E doctors correctly interpretated the radiographs in 95% of examinations.

Guidelines reduce inappropriate x ray requests. Further improvements can be expected with continued education.