Table 2
Author, date and countryPatient groupStudy type (level of evidence)OutcomesKey resultsStudy weaknesses
Roberge RJ et al, 1988, USA467 blunt trauma patients undergoing c-spine radiographProspectiveCervical spine injuryIn alert patients cervical spine pain. Sensitivity 100% (54–100). Cervical spine tenderness, sensitivity 100% (54–100)
Roberge RJ and Wears RC, 1992, USA480 blunt trauma patients undergoing c-spine radiographProspectiveCervical spine injuryClinical examination in alert patients, sensitivity 93% (75–100). Negative predictive value 98.7% (94.9–100)Not all patients included
Total number of blunt trauma victims not known
No search for misses
Hoffman JR et al, 1992, USA974 blunt trauma patients who had radiograph performed and data sheet filled inProspectiveCervical spine fractureAlert patient with no intoxication, midline neck tenderness or distracting injury, sensitivity=100%Not all patients included in the study
No search for misses
Velhamos GC et al, 1996, USA549 blunt trauma patientsProspectiveCervical spine injury or fractureAll patients had normal c-spine examination. No c-spine fractures or cord injuries found
Alert, not intoxicated and no neck pain
Brought to hospital in hard collar
Gonzalez RP et al, 1999, USA2176 consecutive blunt trauma patientsProspectiveCervical spine injuryClinical examination 91% sensitivity for CSI; lateral c-spine screen (xr, swimmers CT) 61% sensitivity for CSIIncludes intoxicated patients
GCs 14 or 15No power calculation
No search for misses
Hoffman JR et al, 2000, USA34069 patients having cervical spine radiograph after blunt traumaProspectiveClinically significant cervical spine injuryDecision instrument (alert with no evidence of intoxication, no midline cervical tenderness and no neurological deficit or distracting injury). Sensitivity of 99.6% (98.6–100) for significant injury, negative predictive value 99.9% (98.8–100)
21 centres