Utility of computed tomography imaging of the cervical spine in trauma evaluation of ground level fall.

BACKGROUND: CT of the cervical spine is routinely ordered for low-risk mechanisms of injury, including ground level fall (GLF). Two commonly employed clinical decision rules (CDRs) to guide C-spine imaging in trauma are the National Emergency X-Radiography Utilization Study (NEXUS) and the Canadian Cervical Spine Rule for Radiography (CCR). METHODS: Retrospective cross-sectional study of 3,753 consecutive adult patients presenting to an urban Level I ED who received C-spine CT scans were obtained over a six month period. The primary outcome of interest was prevalence of cervical spine fracture. Secondary outcomes included fracture stability, appropriateness of imaging by NEXUS and CCR criteria, and estimated radiation dose-exposure and costs associated with C-spine imaging studies. RESULTS: Of the 760 patients meeting inclusion criteria, seven cervical spine fractures were identified (0.92% +/- 0.68%). All fractures were identified by NEXUS and CCR criteria with 100% sensitivity. Of all these imaging studies performed, only 68% met NEXUS indications for imaging (49% met CCR indications). Cervical spine CT scans in patients not meeting CDR indications were associated with costs of $30-43,000 by NEXUS ($29-71,000 by CCR) in this single center during the six-month study period. CONCLUSIONS: For GLF, C-spine CT is over-utilized. The consistent application of CDR criteria would reduce annual nation-wide imaging costs in the US by $13-19 million based on NEXUS ($12-31 million based on CCR), and would reduce population radiation dose-exposure by 0.8-1.1 million mGy based on NEXUS ( 0.7-1.9 million mGy based on CCR) if applied across all level I trauma centers. Greater use of evidence-based CDRs plays an important role in facilitating ED patient management and reducing system-wide radiation dose exposure and imaging expenditures. LEVEL of EVIDENCE: Level II Diagnostic Test (C) 2016 Lippincott Williams & Wilkins, Inc.

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