title: Screening cervical spine CT in a level I trauma center: overutilization?
abstract: OBJECTIVE
  The objective of our study was to analyze the use of screening cervical spine CT performed after trauma and establish the opportunity of potentially avoidable studies when evidence-based clinical criteria are applied before imaging.
  
  
  METHODS
  All cervical spine CT examinations performed in the emergency department of a level 1 trauma center between January and December 2008 on adult patients with trauma were analyzed; 1589 studies were evaluated. Radiology reports and clinical data were reviewed for the presence of fracture or ligamentous injury and for the mode of injury. We also looked for documentation of clinical criteria used to perform the CT study. In particular, we looked for mention of posterior midline cervical tenderness, focal neurologic deficit, level of alertness, evidence of intoxication, and clinically apparent distracting injury. These five criteria were established by the National Emergency X-Radiography Utilization Study (NEXUS) to identify patients with a low probability of cervical spine injury who consequently needed no cervical spine imaging.
  
  
  RESULTS
  Of the 1589 studies reviewed, 41 (2.6%) were positive for an acute cervical spine injury and 1524 (95.9%) were negative. The remaining 24 studies (1.5%) were indeterminate on the initial CT examination but subsequent imaging and clinical follow-up failed to show acute injury. Of the 1524 examinations with no acute injury, 364 (23.9%) had no documentation of any of the five NEXUS low-risk criteria.
  
  
  CONCLUSIONS
  The strict application of the NEXUS low-risk criteria could potentially reduce the number of screening cervical spine CT examinations in the setting of trauma in more than 20% of cases, thereby avoiding a significant amount of unnecessary radiation and significant cost.
authors.affiliation: Department of Radiology, Henry Ford Health System, 2799 W Grand Blvd, Detroit, MI 48202, USA. brentg@rad.hfh.edu
authors.forename: Brent
authors.initials: B
authors.lastname: Griffith
authors.forename: Carrie
authors.initials: C
authors.lastname: Bolton
authors.forename: Nikhil
authors.initials: N
authors.lastname: Goyal
authors.forename: Manuel L
authors.initials: ML
authors.lastname: Brown
authors.forename: Rajan
authors.initials: R
authors.lastname: Jain
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002574:Cervical Vertebrae / Q000000981:diagnostic imaging* / Q000293:injuries*; D016009:Chi-Square Distribution; D005260:Female; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000379:methods*; D008875:Middle Aged; D019838:Neck Injuries / Q000000981:diagnostic imaging*; D014057:Tomography, X-Ray Computed / Q000379:methods*; D014193:Trauma Centers; D014218:Triage