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Absence of 5 clinical criteria ruled out cervical spine injury in blunt trauma in the emergency department

Design
A cohort study using data from a previously developed set of clinical criteria.

Setting
21 clinical centres in the US.

Patients
34 069 patients (mean age 37 y, age range 1–101 y, 59% men) with blunt trauma of the cervical spine who presented to the ED. Patients with penetrating trauma and those who received cervical spine imaging for reasons unrelated to the trauma were excluded.

Description of prediction guide
The 5 previously validated criteria were tenderness at the posterior midline of the cervical spine; focal neurological deficit; abnormal level of alertness; evidence of intoxication; and clinically apparent, painful injury that could distract the patient from the pain of cervical spine injury. Criteria that could not be assessed were considered to be present. The presence of any one finding indicated cervical spine injury. All patients received a standard series of 3 radiographic views of the cervical spine unless computed tomography or magnetic resonance imaging of the entire . . . [Full text of this article]

Ralph Bloch, MD

University of Berne Berne, Switzerland