THE EFFECT OF INTRODUCING GUIDELINES FOR CERVICAL-SPINE RADIOGRAPHS IN THE ACCIDENT AND EMERGENCY DEPARTMENT

Objective-To assess the effect of guidelines for x ray requests on req uests for cervical spine x rays. Setting-Accident and emergency (A&E) department of tertiary referral centre. Methods-Guidelines for all x r ay requests were introduced in the (A&E) department of the Royal Infir mary of Edinburgh in February 1992. The effect of the guidelines on re quests for cervical spine x rays was assessed by retrospective review of all such x rays taken over two 30 d periods, before and after the i ntroduction of the guidelines. Junior staff had been in post for 3 mon ths during both periods assessed. Films were reviewed for quality by a consultant radiologist. Results-Guidelines reduced the number of inap propriate requests significantly; however, 26% of requests were still unnecessary. The standard of radiography improved but 49% of x rays re mained inadequate, usually because the C7/T1 level was not demonstrate d on the lateral view. The A&E doctors correctly interpretated the rad iographs in 95% of examinations. Conclusions-Guidelines reduce inappro priate x ray requests. Further improvements can be expected with conti nued education.