title: Flexion and extension views are not cost-effective in a cervical spine clearance protocol for obtunded trauma patients.
abstract: BACKGROUND
  Between 1994 and 1999, 837 flexion-extension cervical spine films (F/E) were ordered as part of a protocol to evaluate cervical stability in blunt trauma victims, particularly obtunded patients with otherwise normal films. After 5 years' experience with this protocol, a review of its efficiency and cost-effectiveness was performed.
  
  
  METHODS
  The radiology reports and charts were reviewed for positive or suggestive F/E series.
  
  
  RESULTS
  Nearly a third of all series were inadequate to rule out instability. Only four patients were identified who had decreased admission Glasgow Coma Scale score, normal plain films and/or CT, and positive or suggestive findings on F/E. One was felt to be a false positive, and the others had minor or borderline findings; all were treated with continuation of the cervical collar. Although one patient was lost to follow-up, none of the other three required subsequent surgery or developed deformity or neurologic injury.
  
  
  CONCLUSIONS
  Flexion-extension studies were not a cost-effective part of the protocol, and they were dropped.
authors.affiliation: Department of Orthopaedic Surgery, University of Missouri, Columbia, Missouri 65212, USA.
authors.forename: Jeff
authors.initials: J
authors.lastname: Anglen
authors.forename: Michael
authors.initials: M
authors.lastname: Metzler
authors.forename: Paul
authors.initials: P
authors.lastname: Bunn
authors.forename: Harry
authors.initials: H
authors.lastname: Griffiths
mesh_terms: D002574:Cervical Vertebrae / Q000000981:diagnostic imaging* / Q000293:injuries* / Q000503:physiopathology; D003362:Cost-Benefit Analysis; D005189:False Positive Reactions; D015600:Glasgow Coma Scale; D006801:Humans; D007593:Joint Instability / Q000000981:diagnostic imaging / Q000191:economics / Q000503:physiopathology; D020393:Manipulation, Spinal; D011859:Radiography / Q000191:economics*; D016059:Range of Motion, Articular / Q000502:physiology; D013119:Spinal Cord Injuries / Q000000981:diagnostic imaging* / Q000191:economics / Q000503:physiopathology; D014057:Tomography, X-Ray Computed / Q000191:economics; D014949:Wounds, Nonpenetrating / Q000000981:diagnostic imaging* / Q000191:economics / Q000503:physiopathology