Reliability of Indications for Cervical Spine Films in Trauma Patients

Abstract

Common emergency room practice mandates cervical spine (C-spine) films in all trauma patients with potential injuries. With the increasing costs of medical care, such liberal criteria may not be justified. This 1-year prospective study of 860 patients who presented to a Level I Trauma Center was undertaken to determine the signs and symptoms that would select the patients at risk of C-spine injury. The clinical presentation of each patient was correlated with the presence of C-spine fracture. Twenty-four patients (2.8%) had injuries demonstrated by plain film radiography. The incidence of fracture in 536 symptomatic patients was 4%. A significant likelihood of C-spine fracture was seen in patients with respiratory compromise (100%), motor dysfunction (54.5%), and altered sensorium (8.9%) (p < 0.001). No fractures were seen in asymptomatic patients (p < 0.001). Cervical spine radography should be performed in patients with abnormal neurologic findings or symptoms referable to the neck. In alert asymptomatic patients, cervical spine radiography may be omitted.