Selective Application of Cervical Spine Radiography in Alert Victims of Blunt Trauma

Roberge, Raymond J.; Wears, Robert L.; Kelly, Michael C.; Evans, Timothy C.; Kenny, Mary Ann; Daffner, Richard D.; Kremen, Robert; Murray, Kenneth; Cottington, Eric

doi:10.1097/00005373-198806000-00010

Cited by 160 publications

(50 citation statements)

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“…Most trauma victims are transported to hospital with protective measures like a backboard, collar and sandbags -whether or not they have neck symptoms. 5,7 Reports have suggested that clinical judgement is inadequate to predict significant injuries, [8][9][10] and a recent survey found that 97% of 125 US trauma centres routinely ordered C-spine radiography for all trauma patients. 11 Canadian practice is more selective, 6 but there is large variability among hospitals and physicians, and the use of C-spine radiography for alert, stable trauma patients remains inefficient.…”

Section: Utilization Of Cervical Spine Radiographymentioning

confidence: 99%

“…7,9,[12][13][14][15][16][17][18][19][20][21][22] Given the very low yield, many authors consider universal C-spine radiography inefficient. [12][13][14][15][23][24][25] The huge number of normal radiographs adds to health care costs 26,27 and to the burden of time and effort for ED staff.…”

Section: Utilization Of Cervical Spine Radiographymentioning

confidence: 99%

“…33 Many trauma experts believe that a selective approach is preferable but do not provide clear recommendations. 10,11,13,16,22,[34][35][36][37] Most authors feel that radiography is unnecessary in alert patients with no neck pain or tenderness, 5,7,9,12,14,18,[23][24][25][38][39][40][41][42][43][44][45] but only a few are willing to suggest that imaging might be withheld in alert patients with pain but no midline bony tenderness. 15,17,19 Emergency practice is characterized by high case volumes, brief physician-patient contact, uncertain followup and fear of medicolegal repercussions.…”

Section: Previous Guidelines For Cervical Spine Radiographymentioning

confidence: 99%

“…But Canadian and US emergency physicians have differing views on this topic, 49,50 and the consensus is that more research is necessary before C-spine radiography guidelines for alert trauma patients can be implemented. 7,9,11,14,16,17,19,20,24,34,[37][38][39][40]44 Future studies should be rigorous, prospective and involve large numbers of patients.…”

Section: Previous Guidelines For Cervical Spine Radiographymentioning

confidence: 99%

“…Only a few studies gathered data prospectively using data collection forms, 9,10,15,17,19,40,44,45,52 no study described training the physicians to collect data in a standardized fashion, and no study explicitly collected the predictors without knowledge of the outcome. Only 1 study measured interobserver agreement to assess reliability.…”

Section: Previous Guidelines For Cervical Spine Radiographymentioning

confidence: 99%

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Canadian C-Spine Rule study for alert and stable trauma patients: I. Background and rationale

Stiell

Wells

McKnight

et al. 2002

CJEM

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This paper is Part I of a 2-part series to describe the background and methodology for the Canadian C-Spine Rule study to develop a clinical decision rule for rational imaging in alert and stable trauma patients. Current use of radiography is inefficient and variable, in part because there has been a lack of evidence-based guidelines to assist emergency physicians. Clinical decision rules are research-based decision-making tools that incorporate 3 or more variables from the history, physical examination or simple tests. The Canadian CT Head and C-Spine (CCC) Study is a large collaborative effort to develop clinical decision rules for the use of CT head in minor head injury and for the use of cervical spine radiography in alert and stable trauma victims. Part I details the background and rationale for the development of the Canadian C-Spine Rule. Part II will describe in detail the objectives and methods of the Canadian C-Spine Rule study. RÉSUMÉIl s'agit de la première partie d'un article en deux parties décrivant le contexte et la méthodologie de l'étude de la Règle canadienne concernant la colonne cervicale (Canadian C-Spine Rule study) visant à établir une règle de décision pour le recours rationnel à l'imagerie chez les victimes de traumatismes alertes et stables. Le recours actuel à la radiographie est inefficace et variable, en partie en raison d'un manque de lignes directrices fondées sur des données probantes pour guider les urgentologues. Les règles de décision clinique sont des outils de prise de décision fondés sur des recherches qui incorporent trois variables ou plus provenant des antécédents, de l'examen physique ou de simples tests. L'étude canadienne concernant les tomodensitogrammes de la tête et la colonne cervicale (Canadian CT Head and C-Spine Study) est un effort de collaboration sur une grande échelle visant à mettre sur pied des règles de décision clinique quant au recours au tomodensitogramme de la tête dans les cas de blessures mineures à la tête et à la radiographie de la colonne cervicale chez les victimes de traumatismes alertes et stables. La première partie décrit le contexte de la mise sur pied de la Règle canadienne concernant la colonne cervicale et sa justification. La deuxième partie décrira en détail les objectifs et méthodes de l'étude de cette Règle.

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Section: Utilization Of Cervical Spine Radiographymentioning

confidence: 99%

Section: Utilization Of Cervical Spine Radiographymentioning

confidence: 99%

Section: Previous Guidelines For Cervical Spine Radiographymentioning

confidence: 99%

Section: Previous Guidelines For Cervical Spine Radiographymentioning

confidence: 99%

Section: Previous Guidelines For Cervical Spine Radiographymentioning

confidence: 99%

See 3 more Smart Citations

Canadian C-Spine Rule study for alert and stable trauma patients: I. Background and rationale

Stiell

Wells

McKnight

et al. 2002

CJEM

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Magnetic Resonance Imaging Is Not Needed to Clear Cervical Spines in Blunt Trauma Patients With Normal Computed Tomographic Results and No Motor Deficits

Schuster

Waxman²,

Sanchez³

et al. 2005

Arch Surg

113

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Roentgenographic Evaluation of the Cervical Spine

Roth

Martín²,

Foley³

et al. 1994

Arch Surg

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These results indicate that blunt trauma patients may not require cervical spine roentgenography if they meet the following criteria: absence of mental status changes, intoxication, neck pain or tenderness, neurologic signs or symptoms, or simultaneous major distracting injury. Because of the small incidence of cervical spine injuries, further studies are necessary to evaluate the positive predictive value of history and physical examination of the cervical spine in a trauma patient.

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Selective Application of Cervical Spine Radiography in Alert Victims of Blunt Trauma

Cited by 160 publications

References 0 publications

Canadian C-Spine Rule study for alert and stable trauma patients: I. Background and rationale

Canadian C-Spine Rule study for alert and stable trauma patients: I. Background and rationale

Magnetic Resonance Imaging Is Not Needed to Clear Cervical Spines in Blunt Trauma Patients With Normal Computed Tomographic Results and No Motor Deficits

Roentgenographic Evaluation of the Cervical Spine

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