Objectives and Backgrounds The EAST (Eastern Association for the Surgery of Trauma) guidelines define adequate radiography of the cervical spine. Previous studies looking at emergency department cervical spine radiographs have found a significant proportion to be inadequate. This study will ascertain the adequacy of cervical spine imaging on trauma patients in a major London tertiary referral centre. Local reporting of cervical spine radiographs are compared to the gold standard EAST guidelines.

Methods Data were examined from 100 consecutive patients. We applied the EAST criteria retrospectively to all cervical spine radiology undertaken in this cohort of patients to define adequate or inadequate films. We assessed the performance of local radiology reporting.

Results 99% of patients undergoing a full trauma series had at least one inadequate initial image. Of these, 85% had at least one inadequate lateral or peg view. 74% with inadequate initial lateral or peg views had repeats performed. Only 23% of all inadequate initial and repeat lateral or peg views were explicitly reported as inadequate on the radiology report. In total 36% of all trauma patients left the emergency department with inadequate cervical spine imaging (no full trauma series or no repeat after an inadequate film).

Conclusions Inadequate radiography of the cervical spine is common in trauma. Over one-third of trauma patients may not receive adequate imaging of their cervical spine; these findings suggest that there is significant process variability, which is compounded by the heterogamous population. We offer solutions.