title: Screening cervical spine CT in the emergency department, Phase 2: A prospective assessment of use.
abstract: OBJECTIVE
  The National Emergency X-Radiography Utilization Study Low-Risk Criteria were established to identify patients with a low probability of cervical spine injury in whom imaging of the cervical spine was unnecessary. The purpose of this study was to ascertain the number of unnecessary cervical spine CT studies on the basis of proper application of established clinical guidelines and, secondarily, to determine indications for ordering studies in the absence of guideline criteria.
  
  
  METHODS
  All patients presenting to a level I trauma center for whom a screening cervical spine CT was ordered in the setting of blunt trauma were eligible for enrollment. For each study, the requesting clinician completed a survey regarding study indications. CT examinations were evaluated by a board-certified radiologist blinded to survey data to determine the presence or absence of cervical spine injury.
  
  
  RESULTS
  Of 507 CT examinations, 5 (1%) were positive and 497 (98.0%) were negative for acute cervical spine injury. Five studies (1%) were indeterminate for acute injury but demonstrated no abnormality on subsequent imaging and clinical follow-up. Of the 502 studies without cervical spine injury, 81 (16.1%) were imaged despite meeting all 5 NEXUS criteria for nonimaging. Of these, the most common study indication was dangerous mechanism of injury (48.1%) followed by subjective neck pain (40.7%).
  
  
  CONCLUSIONS
  Strict application of NEXUS criteria could potentially reduce the number of screening cervical spine CT scans in the setting of blunt trauma; this change would avoid a considerable amount of unnecessary radiation and cost.
authors.affiliation: Department of Radiology, Henry Ford Health System, Detroit, MI 48202, USA. brentg@rad.hfh.edu
authors.forename: B
authors.initials: B
authors.lastname: Griffith
authors.forename: M
authors.initials: M
authors.lastname: Kelly
authors.forename: P
authors.initials: P
authors.lastname: Vallee
authors.forename: M
authors.initials: M
authors.lastname: Slezak
authors.forename: J
authors.initials: J
authors.lastname: Nagarwala
authors.forename: S
authors.initials: S
authors.lastname: Krupp
authors.forename: C P
authors.initials: CP
authors.lastname: Loeckner
authors.forename: L R
authors.initials: LR
authors.lastname: Schultz
authors.forename: R
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; D004632:Emergency Medical Services / Q000379:methods / Q000706:statistics & numerical data; D005260:Female; D005500:Follow-Up Studies; D019538:Health Care Surveys; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000379:methods / Q000706:statistics & numerical data; D008875:Middle Aged; D019838:Neck Injuries / Q000000981:diagnostic imaging*; D011446:Prospective Studies; D012189:Retrospective Studies; D016103:Spinal Fractures / Q000000981:diagnostic imaging*; D014057:Tomography, X-Ray Computed / Q000706:statistics & numerical data*; D014193:Trauma Centers / Q000706:statistics & numerical data*; D019564:Unnecessary Procedures / Q000706:statistics & numerical data; D014949:Wounds, Nonpenetrating / Q000000981:diagnostic imaging; D055815:Young Adult