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SymbolNew Decision‐Making Tool for Catastrophic Neck Injury

Fear of a catastrophic neck injury drives patients to emergency rooms and medical clinics after all manner of trauma. Fear of missing a catastrophic injury drives physicians to order imaging in most cases. This elevated level of imaging— physicians order roughly 800,000 cervical x-rays every year in the U.S.— leads to high costs and excessive radiation exposure. It also absorbs tens of thousands of hours of valuable time for busy ER physicians and radiologists unnecessarily. A simple new tool—an easily applied set of clinical criteria—offers a rational way for physicians to limit the use of cervical x-rays after trauma. Jerome Hoffman, MD, and colleagues took cervical x-rays in over 34,000 patients after blunt cervical trauma, and then studied how the application of the cervical decision tool would have altered the pattern of imaging. Five criteria (no midline cervical tenderness, no focal neurologic deficit, normal alertness, no intoxication, and no painful distracting injury) would have allowed 12% of trauma victims to avoid cervical x-rays without undue risk. (See Hoffman et al., 2000.) The negative predictive value of the cervical criteria was 99.8, with impressive confidence intervals. Of the 818 individuals who had a significant cervical injury in this study, the decision instrument would have misclassified only eight cases. None of the misclassifications would have resulted in an adverse impact on these subjects’health.