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Evidence summaries

Indications for Cervical x-Ray in Patients with Blunt Trauma

The probability of a cervical fracture appears to be very small in patients who have no local midline tenderness of the neck, no neurological symptoms, and no other diseases that make assessment of the patient difficult. Level of evidence: "B"

A prospective study 1 assessed the accuracy of a clinical decision-making instrument in 34,069 patients with blunt trauma who had cervical radiographs taken in 21 centres in the U.S.A. According to the decision-making instrument the probability of cervical injury is small in patients with no

- local midline tenderness

- focal neurological symptoms

- impaired consciousness

- signs of intoxication

- other painful trauma distracting attention from cervical pain.

The decision-making instrument detected all but 8 of the 818 patients with cervical injury (sensitivity 99%, 95% CI 98.0 to 99.6%). The negative predictive value was 99.8%. The specificity was 12.7% and the positive predictive value was 2.7%.

Comment: The quality of evidence is upgraded by large magnitude of effect.

    References

    • Hoffman JR, Mower WR, Wolfson AB, Todd KH, Zucker MI. Validity of a set of clinical criteria to rule out injury to the cervical spine in patients with blunt trauma. National Emergency X-Radiography Utilization Study Group. N Engl J Med 2000 Jul 13;343(2):94-9. [PubMed]

Primary/Secondary Keywords