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Cervical spine radiography in alert asymptomatic blunt trauma patients
  1. Damian Bates,
  2. John Butler
  1. Department of Emergency Medicine, Manchester Royal Infirmary, Oxford Road, Manchester M13 9WL, UK
  1. kevin.mackway-jones{at}man.ac.uk

Abstract

A short cut review was carried out to establish whether a normal cervical spine radiograph excludes bony cervical spine injury in alert, asymptomatic trauma patients. Altogether 232 papers were found using the reported search, of which six presented the best evidence to answer the clinical question. The author, date and country of publication, patient group studied, study type, relevant outcomes, results and study weaknesses of these best papers are shown in table 2. A clinical bottom line is stated.

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Report by Damian Bates, Specialist Registrar
 Checked by John Butler, Specialist Registrar

Clinical scenario

A 46 year old man is brought to the emergency department after a road traffic accident, involving a rear end shunt, to “get checked out”. He is fully alert and cooperative. You are aware that many people advise radiographs in all patients to exclude cervical spine injury. You wonder whether this is really necessary.

Three part question

In [alert asymptomatic blunt trauma patients] is [cervical spine radiography] necessary to [exclude bony injury to the cervical spine]?

Search strategy

Medline 1966–10/01 using the OVID interface. [exp cervical vertebrae OR exp spinal cord injuries OR exp spinal fractures OR exp spinal injuries OR cervical spine injury.mp] AND [exp x-rays OR x-rays.mp OR exp radiography OR radiograph$.mp OR cervical radiograph$.mp] AND [exp prospective studies OR prospective studies.mp]. LIMIT to human and English.

Search outcome

Altogether 232 papers were identified of which six were relevant.

Comment(s)

Several prospective studies have been done on this topic, and all reach roughly the same conclusion. However, in this potentially disastrous situation all authors are keen to point out that any clinical decision strategy can never be 100% sensitive and should be used on an individual patient basis rather than as an unbendable rule.

CLINICAL BOTTOM LINE

Victims of blunt trauma who are fully alert and show no signs of intoxication can safely forego cervical spine radiography if they have no midline neck tenderness, no neurological deficit and no distracting injury.

Table 2
Table 3

Report by Damian Bates, Specialist Registrar
 Checked by John Butler, Specialist Registrar

References

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