ARE CERVICAL SPINE X-RAYS MANDATORY IN ALL MULTIPLE-TRAUMA PATIENTS?

Abstract

Traumatic cervical spine injuries may result in severe disability or death unless promptly diagnosed and treated. It is recommended by ADVANCED TRAUMA LIFE SUPPORT guidelines that three-view cervical spine X-rays be obtained routinely in all multiple-trauma patients. In this retrospective study, we evaluated whether cervical spine X-rays are indeed necessary in all such patients.

The inclusion criteria for our study were that patients had to be conscious, oriented, cooperative, and non-intoxicated. Among the 303 multiple-trauma patients presenting to our Emergency Department between January 1 and December 31, 1993. 267 patients met inclusion criteria and had completed charts. Cervical spine injuries were diagnosed in 13 (%5) of the study patients, all of whom either complained of neck pain or had neck tenderness on initial examination. Of those patients discovered to have cervical spine injuries, 3 (23%) also had abnormal neurologic examinations. Among patients without neck pain and/or tenderness, none were found to have cervical spine injury.

As a result, we concluded that neck pain and/or tenderness is a valid criteria for the prompt diagnosis of cervical spine injures and routine cervical spine X-rays are unnecessary for multiple-trauma patients meeting all of the following criteria:

1) The patient is conscious, oriented, cooperative, non-intoxicated,
2) The patient does not have neck pain and/or tenderness.

Omitting cervical X-rays speeds patient evaluation, protects the medical staff and patient from unnecessary exposure to radiation, and reduces treatment costs.