Efficacy of radiographic evaluation of the cervical spine in emergency situations

Evaluation of trauma to the cervical spine usually includes predominantly normal x-ray studies that prevent expeditious workup and treatment and increase cost. In a retrospective review of the cases of 1,686 consecutive trauma patients who had routine radiographs for possible injury to the cervical spine, injuries were detected in 32 (1.9%). In a similar consecutive group of 597 patients whose cases were more critically analyzed prospectively, 17 (2.8%) had suspected injuries; of these, five (0.8%) were true positives. All patients in the prospective group with suspected injuries had neck pain, neurologic deficit, or altered consciousness, suggesting that emergency radiographic screening according to more selective clinical criteria may be feasible.