title: Application of clinical criteria for ordering radiographs to detect cervical spine fractures.
abstract: OBJECTIVE
  The aim of the study was to determine if spinal-immobilized patients met clinical criteria for x-rays and which clinical criteria were associated with cervical fractures.
  
  
  METHODS
  This was a prospective, observational analysis of clinical findings and radiograph results for patients transported to the emergency department in spinal immobilization by emergency medical services. The presence of altered mentation, distracting injury, cervical spine tenderness, neck pain, neurologic deficit, and palpable deformity was recorded for each subject.
  
  
  RESULTS
  Of the 2044 subjects enrolled in the study, 1367 subjects received radiographs and 50 had cervical spine fractures. Sixty percent of subjects met some clinical criteria for radiograph ordering. Cervical spine tenderness and neurologic deficit were the only clinical criteria statistically associated with fractures. All subjects with fractures met 1 or more of the clinical criteria for radiographs.
  
  
  CONCLUSIONS
  Cervical spine radiographs were ordered for a significant number of patients who did not meet the clinical criteria. However, omission of any one of the criterion other than palpable deformity would have potentially resulted in a missed fracture. Strictly following the criteria would have significantly reduced the number of cervical spine radiographs taken.
authors.affiliation: Department of Emergency Medicine, State University of New York at Buffalo, NY 14215, USA. moscati@buffalo.edu
authors.forename: Ronald M
authors.initials: RM
authors.lastname: Moscati
authors.forename: E Brooke
authors.initials: EB
authors.lastname: Lerner
authors.forename: Jennifer L
authors.initials: JL
authors.lastname: Pugh
mesh_terms: D002574:Cervical Vertebrae / Q000293:injuries* / Q000503:physiopathology; D016001:Confidence Intervals; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D006801:Humans; D011446:Prospective Studies; D011859:Radiography; D012149:Restraint, Physical; D016103:Spinal Fractures / Q000000981:diagnostic imaging*; D014193:Trauma Centers