Emerg Med J 29:995-997 doi:10.1136/emermed-2011-200613
  • Original articles

A retrospective analysis of cervical spine radiography in a specialist trauma unit for head injury

  1. Jonathan Costello2
  1. 1University College London Medical School, London, UK
  2. 2Accident and Emergency Department and Department of Emergency Medicine, Royal Free Hospital, London, UK
  1. Correspondence to Dr Alex Baneke, 61b Stroud Green Road, Finsbury Park, London N4 3EG, UK; alexbaneke{at}
  1. Contributors All authors contributed to writing the article. AJB came up with the idea for the study, wrote the first draft. All authors analysed the x-rays. JC designed the flow charts and contributed significantly to the revisions.

  • Accepted 26 January 2012
  • Published Online First 9 March 2012


Objectives The performance of an adequate and complete series of cervical radiographs in the trauma patient is essential in order to ensure safe trauma management. Eastern Association for the Surgery of Trauma (EAST) has produced widely recognised guidelines with which trauma units should comply. The aim of the study is to ascertain the adequacy of cervical spine imaging of trauma patients in a specialist trauma unit (head injury) using EAST guidelines as gold standard. An additional assessment of institutional reporting accuracy is conducted.

Methods Data were examined from 81 consecutive trauma patients requiring cervical spine radiography. EAST guidelines were applied retrospectively to this cohort in order to define guideline compliance. An additional cohort assessment was conducted addressing the accuracy and adequacy of the formal institutional reports associated with these radiographs.

Results 99% of patients undergoing a full cervical trauma series had at least one inadequate initial image. Of these, 85% had at least one inadequate lateral or peg view (of which 26% did not have repeat radiographs performed). Over one-third of all trauma patients left the emergency department with inadequate cervical spine imaging (incomplete cervical spine series or inadequate films). From the institutional reporting perspective, only 27% of all inadequate initial and repeat lateral or peg views were subsequently explicitly reported as being inadequate.

Discussion These findings call into question current practice. Clearly, multiple confounders exist in the context of process variability in a heterogeneous population such as that attending an emergency department. This study offer solutions to address this problem.


  • Competing interests None.

  • Ethics approval Approval was not needed as the study involved database of patient radiographs and anonymised patient details. There were no direct patient care interventions.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement The data are available on the picture archiving and communication system database to the staff of Royal Free Hospital.

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Among patients with minor TBI (GCS 13-15) getting CT scans ≥ 24 hours after injury, what proportion have a traumatic finding?


0.5% - 43% response rate
3% - 41% response rate
10% - 16% response rate

Related original article: PCT head imaging in patients with head injury who present after 24 h of injury: a retrospective cohort study

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