title: Is the lateral cervical spine plain film obsolete?
abstract: BACKGROUND
  The objective of this study was to determine the utility of a lateral cervical spine plain film in the evaluation of blunt trauma patients.
  
  
  METHODS
  We prospectively evaluated blunt trauma patients from February 2004 to September 2006 who had both a lateral cervical spine (LCS) film and a computed tomography of the cervical spine (CTC), comparing the diagnostic accuracy of the LCS to the CTC.
  
  
  RESULTS
  There were 1004 patients who met inclusion criteria. Eighty-four patients had a cervical spine fracture while 920 patients had no fracture on CTC. Of the 84 patients with fractures by CTC, 68 had a negative or incomplete LCS. Of the 920 negative CTC, there were 7 false positive LCSs. LCS compared with CTC showed a sensitivity of 19% (16/84) and positive predictive value of 69.6% (16/23). Of the 981 negative or incomplete LCS films, 96.9% were incomplete (951/981). Of the seven patients with a false positive LCS (negative CTC), none was subsequently found to have a cervical spine fracture on further evaluation. Elimination of the LCS would result in charge savings of $265,056.00 (LCS charges with interpretation, $264 each) and increase patient safety by eliminating error.
  
  
  CONCLUSIONS
  LCS has no value as a screening tool in the blunt trauma patient since most are either inaccurate or incomplete. It should be eliminated from the Advanced Trauma Life Support algorithm, and CTC should receive emphasis as the diagnostic gold standard.
authors.affiliation: Division of Trauma, Critical Care, and Emergency General Surgery, Virginia Commonwealth University Medical Center, Richmond, Virginia 23298, USA. tmduane@vcu.edu
authors.forename: Therèse M
authors.initials: TM
authors.lastname: Duane
authors.forename: Tracey
authors.initials: T
authors.lastname: Dechert
authors.forename: Holly
authors.initials: H
authors.lastname: Brown
authors.forename: Luke G
authors.initials: LG
authors.lastname: Wolfe
authors.forename: Ajai K
authors.initials: AK
authors.lastname: Malhotra
authors.forename: Michel B
authors.initials: MB
authors.lastname: Aboutanos
authors.forename: Rao R
authors.initials: RR
authors.lastname: Ivatury
mesh_terms: D002574:Cervical Vertebrae / Q000000981:diagnostic imaging* / Q000293:injuries; D006801:Humans; D011446:Prospective Studies; D011859:Radiography / Q000191:economics; D016103:Spinal Fractures / Q000000981:diagnostic imaging*; D014057:Tomography, X-Ray Computed