THE COST-EFFECTIVENESS OF OBLIQUE RADIOGRAPHY IN THE EXCLUSION OF C7-T1 INJURY IN TRAUMA PATIENTS

OBJECTIVE. The purpose of our study was to compare the cost-effectiven ess of bilateral oblique radiography with that of CT for excluding C7- T1 injury in trauma patients. MATERIALS AND METHODS. Using a historica l cohort model, we retrospectively studied two distinct groups of trau ma patients. In the first group, which included 196 patients, CT was p erformed to show C7-T1 anatomy when this region was not adequately rev ealed on initial three-view cervical spine radiography. In the second group, which included 129 patients, routine three-view radiography was complemented by bilateral oblique views. If these five views failed t o adequately reveal C7-T1 anatomy, CT was then performed to show the c ervicothoracic junction. Using Medicare reimbursement data, we then co mpared the cost-effectiveness of CT with that of oblique radiography i n terms of cost per cervical spine imaged completely to the level of C 7-T1. RESULTS. In the first group, 50 (26%) of 196 patients underwent CT when C7-T1 anatomy was not adequately revealed on routine three-vie w cervical spine radiography. In the second group, only 17 (13%) of th e 129 patients required CT when five-view radiography failed to adequa tely reveal C7-T1 anatomy. This difference was statistically significa nt (p <.01). The cost per completely imaged cervical spine was $92.00 when bilateral oblique radiographs were routinely obtained, compared w ith $116.28 per completely imaged cervical spine when these views were not obtained. CONCLUSION. Because bilateral oblique radiography appea rs to be cost-effective for the exclusion of cervical spine injuries, we suggest that it be performed routinely.