title: Can emergency physicians accurately rule out clinically important cervical spine injuries by using computed tomography?
abstract: OBJECTIVE
  Emergency physicians are expected to rule out clinically important cervical spine injuries using clinical skills and imaging. Our objective was to determine whether emergency physicians could accurately rule out clinically important cervical spine injuries using computed tomographic (CT) imaging of the cervical spine.
  
  
  METHODS
  Fifteen emergency physicians were enrolled to interpret a sample of 50 cervical spine CT scans in a nonclinical setting. The sample contained a 30% incidence of cervical spine injury. After a 2-hour review session, the participants interpreted the CT scans and categorized them into either a suspected cervical spine injury or no cervical spine injury. Participants were asked to specify the location and type of injury. The gold standard interpretation was the combined opinion of two staff radiologists.
  
  
  RESULTS
  Emergency physicians correctly identified 182 of the 210 abnormal cases with cervical spine injury. The sensitivity of emergency physicians was 87% (95% confidence interval [CI] 82-91), and the specificity was 76% (95% CI 74-77). The negative likelihood ratio was 0.18 (95% CI 0.12-0.25).
  
  
  CONCLUSIONS
  Experienced emergency physicians successfully identified a large proportion of cervical spine injuries on CT; however, they were not sufficiently sensitive to accurately exclude clinically important injuries. Emergency physicians should rely on a radiologist review of cervical spine CT scans prior to discontinuing cervical spine precautions.
authors.forename: Hendrik P
authors.initials: HP
authors.lastname: Van Zyl
authors.forename: James
authors.initials: J
authors.lastname: Bilbey
authors.forename: Alan
authors.initials: A
authors.lastname: Vukusic
authors.forename: Todd
authors.initials: T
authors.lastname: Ring
authors.forename: Jennifer
authors.initials: J
authors.lastname: Oakes
authors.forename: Lykke D
authors.initials: LD
authors.lastname: Williamson
authors.forename: Ian V
authors.initials: IV
authors.lastname: Mitchell
mesh_terms: D002574:Cervical Vertebrae / Q000000981:diagnostic imaging / Q000293:injuries*; D002983:Clinical Competence; D003951:Diagnostic Errors / Q000706:statistics & numerical data; D006801:Humans; D010820:Physicians / Q000592:standards*; D011237:Predictive Value of Tests; D012372:ROC Curve; D015203:Reproducibility of Results; D013124:Spinal Injuries / Q000000981:diagnostic imaging*; D014057:Tomography, X-Ray Computed / Q000379:methods*; D014193:Trauma Centers / Q000706:statistics & numerical data*