title: Utility of computed tomographic imaging of the cervical spine in trauma evaluation of ground-level fall.
abstract: Computed tomography (CT) of the cervical spine (C-spine) is routinely ordered for low-risk mechanisms of injury, including ground-level fall. Two commonly used clinical decision rules (CDRs) to guide C-spine imaging in trauma are the National Emergency X-Radiography Utilization Study (NEXUS) and the Canadian Cervical Spine Rule for Radiography (CCR).
  
  
  
  Retrospective cross-sectional study of 3,753 consecutive adult patients presenting to an urban Level I emergency department who received C-spine CT scans were obtained over a 6-month period. The primary outcome of interest was prevalence of C-spine fracture. Secondary outcomes included fracture stability, appropriateness of imaging by NEXUS and CCR criteria, and estimated radiation dose exposure and costs associated with C-spine imaging studies.
  
  
  
  Of the 760 patients meeting inclusion criteria, 7 C-spine fractures were identified (0.92% ± 0.68%). All fractures were identified by NEXUS and CCR criteria with 100% sensitivity. Of all these imaging studies performed, only 69% met NEXUS indications for imaging (50% met CCR indications). C-spine CT scans in patients not meeting CDR indications were associated with costs of $15,500 to $22,000 by NEXUS ($14,600-$25,600 by CCR) in this single center during the 6-month study period.
  
  
  
  For ground-level fall, C-spine CT is overused. The consistent application of CDR criteria would reduce annual nationwide imaging costs in the United States by $6.8 to $9.6 million based on NEXUS ($6.4-$15.6 million based on CCR) and would reduce population radiation dose exposure by 0.8 to 1.1 million mGy based on NEXUS (0.7-1.9 million mGy based on CCR) if applied across all Level I trauma centers. Greater use of evidence-based CDRs plays an important role in facilitating emergency department patient management and reducing systemwide radiation dose exposure and imaging expenditures.
  
  
  
  Diagnostic study, level III.
authors.affiliation: From the Departments of Radiology and Imaging Sciences (M.D.B., J.W.A., M.U., C.A.H.), and Neurology (J.W.A.), School of Medicine (M.D.B., J.W.A., B.P.L., M.U., R.M.S., C.A.H.), Emory University, Atlanta, Georgia.
authors.forename: Marc D
authors.initials: MD
authors.lastname: Benayoun
authors.forename: Jason W
authors.initials: JW
authors.lastname: Allen
authors.forename: Brendan P
authors.initials: BP
authors.lastname: Lovasik
authors.forename: Matthew L
authors.initials: ML
authors.lastname: Uriell
authors.forename: Robert M
authors.initials: RM
authors.lastname: Spandorfer
authors.forename: Chad A
authors.initials: CA
authors.lastname: Holder
mesh_terms: D000058:Accidental Falls; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002574:Cervical Vertebrae / Q000000981:diagnostic imaging* / Q000293:injuries*; D003430:Cross-Sectional Studies; D003661:Decision Support Techniques; D004636:Emergency Service, Hospital; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D019838:Neck Injuries / Q000000981:diagnostic imaging* / Q000209:etiology; D011829:Radiation Dosage; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D016103:Spinal Fractures / Q000000981:diagnostic imaging* / Q000209:etiology; D014057:Tomography, X-Ray Computed / Q000191:economics / Q000706:statistics & numerical data*; D014481:United States