Gc. Velmahos et al., RADIOGRAPHIC CERVICAL-SPINE EVALUATION IN THE ALERT ASYMPTOMATIC BLUNT TRAUMA VICTIM - MUCH ADO ABOUT NOTHING, The journal of trauma, injury, infection, and critical care, 40(5), 1996, pp. 768-774
Objective: To evaluate the hypothesis that alert nonintoxicated trauma
patients with negative clinical examinations are at no risk of cervic
al spine injury and do not need any radiographic investigation, Design
: Prospective study, Setting: A university-affiliated teaching county
hospital, Patients: Five hundred and forty-nine consecutive alert, ori
ented, and clinically nonintoxicated blunt trauma victims with no neck
symptoms, Results: All patients had negative clinical neck examinatio
ns, After radiographic assessment, no cervical spine injuries were ide
ntified, Less than half the patients could be evaluated adequately wit
h the three standard initial views (anteroposterior, lateral, and odon
toid), All the rest needed more radiographs and/or computed tomographi
c scans, A total of 2,272 cervical spine radiographs, 78 computed tomo
graphic scans and magnetic resonance imagings were performed, Seventee
n patients stayed one day in the hospital for no other reason but radi
ographic clearance of an asymptomatic neck, The total cost for x-rays
and extra hospital days was $242,000, These patients stayed in the col
lar for an average of 3.3 hours (range, 0.5-72 hours), There was never
an injury missed, Conclusions: Clinical examination alone can reliabl
y assess all blunt trauma patients who are alert, nonintoxicated, and
report no neck symptoms, In the absence of any palpation or motion nec
k tenderness during examination, the patient may be released from cerv
ical spine precautions without any radiographic investigations.