Brent Griffith MD, Presenter: Nothing to Disclose

Carrie E Bolton MD, Abstract Co-Author: Nothing to Disclose

Nikhil Goyal MD, Abstract Co-Author: Nothing to Disclose

Manuel L. Brown MD, Abstract Co-Author: Investor, RadExchange, LLC

Rajan Jain MD, Abstract Co-Author: Research support, General Electric Company

To analyze the use of screening cervical spine CT performed following trauma and establish the number of potentially avoidable studies when strict clinical criteria are applied prior to imaging. NEXUS criteria have been shown to reduce unnecessary screening cervical spine CT scans in patients with trauma.

A search was performed for all cervical spine CT examinations performed in the Henry Ford Health System emergency departments between January 2008 and December 2008 on adult patients with trauma. The search resulted in 2224 studies performed with a history of fall, assault or motor vehicle accident with the indication to rule out a fracture. Radiology reports and clinical data were reviewed for the presence of fracture or ligamentous injury, mode of injury; and for the clinical criteria used to obtain the CT study, i.e. the NEXUS criteria (posterior midline cervical tenderness, focal neurological deficit, level of alertness, evidence of intoxication, clinically apparent distracting injury), and liberalized NEXUS criteria (paravertebral tenderness, limited/painful range of motion in addition to NEXUS criteria). A subset of patients were also reviewed to assess the mean effective radiation dose resulting from these studies.

Of 890 studies reviewed to date, 19 (2.1%) were positive for definite fracture or ligamentous injury and 860 (96.6%) were negative. 11 studies (1.2%) were indeterminate for acute injury, but further review of clinical records and subsequent imaging failed to demonstrate an acute abnormality. Of the 860 negative studies, 235 (27.3%) had no documented positive NEXUS criteria. Using liberalized NEXUS criteria, 174 (20.2%) still had no documented positive criteria. While new imaging protocols have reduced radiation doses from 2008, the average radiation exposure for a subset of patients in this study was 10.4 mSv.

The strict application of the NEXUS criteria would significantly reduce the number of screening cervical spine CT scans in the setting of trauma, thereby avoiding a significant amount of unnecessary radiation and cost.

Reducing unnecessary screening cervical spine CT scans in patients presenting with trauma by applying strict clinical guidelines could reduce the radiation exposure to a large population of patients.

Griffith, B, Bolton, C, Goyal, N, Brown, M, Jain, R, Screening Cervical Spine CT in a Level I Trauma Center: Over Utilization?.  Radiological Society of North America 2010 Scientific Assembly and Annual Meeting, November 28 - December 3, 2010 ,Chicago IL. http://archive.rsna.org/2010/9002609.html