RADIOGRAPHIC CERVICAL-SPINE EVALUATION IN THE ALERT ASYMPTOMATIC BLUNT TRAUMA VICTIM - MUCH ADO ABOUT NOTHING

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.