Does the National Emergency X-ray Utilization Study make a difference?

Abstract

Introduction of the National Emergency X-ray Utilization Study guidelines to a UK emergency department did not reduce the number of patients having cervical spine radiographs after neck trauma and had no effect on the pick-up rate for cervical spine injuries.

Effectiveness of Implementing Evidence‐based Interventions to Reduce C‐spine Image Ordering in the Emergency Department: A Systematic Review

“…The characteristics of the included studies are highlighted in Table . The included studies were conducted in the United Kingdom, Australia, the United States, and Canada . Six studies were before–after studies and one study was a cluster RCT .…”

“…The years of publication ranged from 1995 to 2009. Two studies reported enrolling patients from 1988 to 1991, while three studies reported enrolling patients between 2000 and 2003 . Two studies were published in 2009 but did not specify the patient enrollment dates .…”

Assessment of Neck Pain and Its Associated Disorders

“…These protocols were tested against a 3-view radiograph as the gold standard, and appear to have an extremely low risk of missing a serious injury in this group. [13][14][15][16][17][19][20][21][22][23]31,32 • There is consistent evidence that CT-scan (7 studies phase II and III) is more sensitive for finding significant cervical spine injury than plain 3-view radiograph in patients (adult and elderly) with cervical trauma for high risk and/or multi-injured blunt trauma neck patients seeking care in an emergency room. 10 • There is consistent evidence that the clinical physical examination is generally more predictive at excluding ("ruling out") a structural lesion or neurologic compression than at diagnosing ("ruling in") root compression and radiculopathy.…”

“…[13][14][15] • The Nexus Low-Risk Criteria (NLC) [16][17][18][19][20][21][22] Tested against a gold standard of radiography (standard 3-view radiograph including lateral, anteroposterior, and open mouth views), both the CCR and the NLC instruments performed well with a high sensitivity and excellent negative predictive value for ruling out serious injury in alert patients with "low risk" neck trauma. Thus, they effectively inform clinicians on optimal test ordering in patients presenting with low-risk neck trauma ( Table 2).…”

“…[13][14][15][16][17][18][19][20][21][22] There is strong evidence to suggest that use of routine cervical spine radiographs alone, (compared to CT scans) may miss important injuries in the evaluation of patients with traumatic high-risk neck injuries in emergency situations, and that CT scan should be used instead. 10,[24][25][26][27][28][29][30] Coupled with the fact that there is important variability in reading the plain radiographs and that there is good evidence to suggest that the CT scan has a superior performance, routine radiographs alone may be superseded by CT in the setting of acute neck trauma in high-risk patients.…”