title: Yield of computed tomography of the cervical spine in cases of simple assault.
abstract: BACKGROUND
  Computed tomography (CT) of the cervical spine (C-spine) is routinely ordered for low-impact, non-penetrating or "simple" assault at our institution and others. Common clinical decision tools for C-spine imaging in the setting of trauma include the National Emergency X-Radiography Utilization Study (NEXUS) and the Canadian Cervical Spine Rule for Radiography (CCR). While NEXUS and CCR have served to decrease the amount of unnecessary imaging of the C-spine, overutilization of CT is still of concern.
  
  
  METHODS
  A retrospective, cross-sectional study was performed of the electronic medical record (EMR) database at an urban, Level I Trauma Center over a 6-month period for patients receiving a C-spine CT. The primary outcome of interest was prevalence of cervical spine fracture. Secondary outcomes of interest included appropriateness of C-spine imaging after retrospective application of NEXUS and CCR. The hypothesis was that fracture rates within this patient population would be extremely low.
  
  
  RESULTS
  No C-spine fractures were identified in the 460 patients who met inclusion criteria. Approximately 29% of patients did not warrant imaging by CCR, and 25% by NEXUS. Of note, approximately 44% of patients were indeterminate for whether imaging was warranted by CCR, with the most common reason being lack of assessment for active neck rotation.
  
  
  CONCLUSIONS
  Cervical spine CT is overutilized in the setting of simple assault, despite established clinical decision rules. With no fractures identified regardless of other factors, the likelihood that a CT of the cervical spine will identify clinically significant findings in the setting of "simple" assault is extremely low, approaching zero. At minimum, adherence to CCR and NEXUS within this patient population would serve to reduce both imaging costs and population radiation dose exposure.
authors.affiliation: Emory University School of Medicine, Atlanta, GA, United States; Department of Radiology and Imaging Sciences, Emory University, Atlanta, GA, United States. Electronic address: muriell@emory.edu.
authors.forename: Matthew L
authors.initials: ML
authors.lastname: Uriell
authors.affiliation: Emory University School of Medicine, Atlanta, GA, United States; Department of Radiology and Imaging Sciences, Emory University, Atlanta, GA, United States; Department of Neurology, Emory University, Atlanta, GA, United States. Electronic address: jason.w.allen@emory.edu.
authors.forename: Jason W
authors.initials: JW
authors.lastname: Allen
authors.affiliation: Emory University School of Medicine, Atlanta, GA, United States; Department of Surgery, Emory University, Atlanta, GA, United States. Electronic address: brendan.p.lovasik@emory.edu.
authors.forename: Brendan P
authors.initials: BP
authors.lastname: Lovasik
authors.affiliation: Emory University School of Medicine, Atlanta, GA, United States; Department of Radiology and Imaging Sciences, Emory University, Atlanta, GA, United States. Electronic address: marc.benayoun@emory.edu.
authors.forename: Marc D
authors.initials: MD
authors.lastname: Benayoun
authors.affiliation: Emory University School of Medicine, Atlanta, GA, United States. Electronic address: robert.spandorfer@emory.edu.
authors.forename: Robert M
authors.initials: RM
authors.lastname: Spandorfer
authors.affiliation: Emory University School of Medicine, Atlanta, GA, United States; Department of Radiology and Imaging Sciences, Emory University, Atlanta, GA, United States. Electronic address: cholder@emory.edu.
authors.forename: Chad A
authors.initials: CA
authors.lastname: Holder
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000465:Algorithms; D002574:Cervical Vertebrae / Q000000981:diagnostic imaging* / Q000293:injuries; D019548:Crime Victims; D003430:Cross-Sectional Studies; D003661:Decision Support Techniques; D004636:Emergency Service, Hospital; D005260:Female; D005845:Georgia / Q000453:epidemiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D019838:Neck Injuries / Q000000981:diagnostic imaging* / Q000453:epidemiology / Q000628:therapy; D012189:Retrospective Studies; D013124:Spinal Injuries / Q000000981:diagnostic imaging* / Q000453:epidemiology / Q000628:therapy; D014057:Tomography, X-Ray Computed; D014193:Trauma Centers; D014754:Violence; D014949:Wounds, Nonpenetrating / Q000000981:diagnostic imaging* / Q000453:epidemiology / Q000628:therapy; D055815:Young Adult
keywords: Canadian C-spine Rule; Cervical spine fracture; Computed tomography; NEXUS; Simple assault