title: Screening cervical spine CT in the emergency department, phase 3: increasing effectiveness of imaging.
abstract: OBJECTIVE
  The aim of this study was to determine the effect of a clinical education initiative on the appropriate utilization of screening cervical spine CT in the emergency department. The purpose was to assess if clinical education can produce stricter adherence to the ACR Appropriateness Criteria and improve the utilization of screening CT examinations in the emergency department.
  
  
  METHODS
  Institutional review board approval was obtained for this HIPAA-compliant study. All adult patients presenting to a level 1 trauma center with blunt trauma prompting screening cervical spine CT were eligible. For each study, the requesting clinician completed a survey selecting all clinical indications. CT examinations were evaluated by a board-certified radiologist blinded to survey data. Results were compared with retrospective and prospective studies performed before the institution of the education initiative.
  
  
  RESULTS
  Of the 388 cervical spine CT examinations performed, 12 (3.1%) were positive for acute cervical spine injury, compared to only 1.0% before the clinical education program (phase 2). Of the 376 examinations without injury, 13% met all 5 National Emergency X-Radiography Utilization Study criteria for nonimaging (down from 16.1% in phase 2), and 15 (4%) required no imaging when both National Emergency X-Radiography Utilization Study and abbreviated Canadian cervical spine rule criteria were applied.
  
  
  CONCLUSIONS
  Implementation of a clinical education initiative resulted in improved adherence to ACR Appropriateness Criteria and improved clinical effectiveness of the studies by increasing fracture detection rate. Initiatives such as these could potentially influence imaging overutilization without burdening emergency department clinicians with excessive roadblocks to image ordering.
authors.affiliation: Department of Radiology, Henry Ford Health System, Detroit, Michigan. Electronic address: brentg@rad.hfh.edu.
authors.forename: Brent
authors.initials: B
authors.lastname: Griffith
authors.affiliation: Department of Emergency Medicine, Henry Ford Health System, Detroit, Michigan.
authors.forename: Phyllis
authors.initials: P
authors.lastname: Vallee
authors.affiliation: Department of Emergency Medicine, Henry Ford Health System, Detroit, Michigan.
authors.forename: Seth
authors.initials: S
authors.lastname: Krupp
authors.affiliation: Department of Radiology, Henry Ford Health System, Detroit, Michigan.
authors.forename: Melissa
authors.initials: M
authors.lastname: Jung
authors.affiliation: Department of Emergency Medicine, Henry Ford Health System, Detroit, Michigan.
authors.forename: Michelle
authors.initials: M
authors.lastname: Slezak
authors.affiliation: Department of Emergency Medicine, Henry Ford Health System, Detroit, Michigan.
authors.forename: Jumana
authors.initials: J
authors.lastname: Nagarwala
authors.affiliation: Department of Emergency Medicine, Henry Ford Health System, Detroit, Michigan.
authors.forename: C Patrick
authors.initials: CP
authors.lastname: Loeckner
authors.affiliation: Department of Public Health Sciences, Henry Ford Health System, Detroit, Michigan.
authors.forename: Lonni R
authors.initials: LR
authors.lastname: Schultz
authors.affiliation: Department of Radiology, Henry Ford Health System, Detroit, Michigan; Department of Radiology, NYU Langone Medical Center, New York, New York.
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*; D002983:Clinical Competence / Q000592:standards / Q000706:statistics & numerical data*; D004636:Emergency Service, Hospital / Q000592:standards* / Q000706:statistics & numerical data; D019983:Guideline Adherence / Q000706:statistics & numerical data; D006801:Humans; D007318:Inservice Training / Q000592:standards / Q000706:statistics & numerical data; D008403:Mass Screening / Q000592:standards; D008824:Michigan; D008875:Middle Aged; D011859:Radiography; D011871:Radiology / Q000193:education; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D013124:Spinal Injuries / Q000000981:diagnostic imaging*; D014949:Wounds, Nonpenetrating / Q000000981:diagnostic imaging*; D055815:Young Adult
keywords: Canadian cervical spine rule; Cervical spine; NEXUS; appropriateness criteria; utilization