Brent Griffith
This study was the second phase of a collaborative effort between the departments of radiology and emergency medicine, aiming to evaluate and address potentially inappropriate utilization of screening cervical spine CT in the emergency department.
Blunt trauma with potential cervical spine injury is a common reason for presentation to emergency departments. Because failure to diagnose injury of the cervical spine can have disastrous consequences, there is often a low threshold for imaging, which can lead to the performance of unnecessary examinations.
One method of addressing overuse of imaging is through the establishment of evidence-based clinical guidelines. Two commonly used decision rules for cervical spine imaging include the National Emergency X-Radiography Utilization Study (NEXUS) Low-Risk Criteria (NLC) and the Canadian Cervical Spine Rule (CCR), both of which are included in the American College of Radiology (ACR) appropriateness guidelines.1,2 However, despite the existence of clinical screening guidelines, a prior retrospective study performed at our institution found that a significant proportion of patients underwent cervical spine imaging without meeting the appropriate criteria.3
This article discusses our prospective study, which evaluated the number of unnecessary cervical spine CT studies based on proper application of established clinical guidelines. We found that in imaged patients without cervical spine injury, a considerable number could have avoided imaging. In total, 16.1% of these patients met all 5 NEXUS criteria for non-imaging, and 28.9% met an abbreviated version of the CCR criteria for non-imaging. Thus, we found that strict application of clinical criteria could considerably reduce the number of screening cervical spine CT scans performed in the setting of blunt trauma, thereby avoiding a considerable amount of unnecessary radiation and cost.