Cervical Spine Injury

First Author	Year	Reference Title	Compliance in the 4 Quality Categories Defined study pop / Prospective / Who looked at films / What studies	Conclusions
Bachulis BL	1987	Clinical indications for cervical spine radiographs in the traumatized patient. Am J Surg 153:473-8	Y / Y / N / N	Prospective study of 1823 consecutive trauma patients who had cervical spine radiographs. 5% incidence of spine injury, all had decreased mental status, pain, or neuro deficits. No case was missed with full C-spine series.
Beirne JC	1995	Cervical spine injuries in patients with facial fractures: A 1-year prospective study. Int J Oral Maxillofac Surg 24:26-9	Y / Y / N / Y	Prospective study of 582 consecutive patients with facial fractures had 3 views + CT, flex/ex if indicated. 1.04% incidence of spine fracture; 5/6 had mandible fractures. All alert patients had neck pain.
Borock EC	1991	A prospective analysis of a two-year experience using computed tomography as an adjunct for cervical spine clearance. J Trauma 31:1001-6	Y / Y / N / Y	Prospective study of 179 consecutive trauma patients who had CT as an adjunct to plain films. CT and 3 view plain x-rays detected 100% if injuries.
Cadoux CG	1987	High-yield roentgenographic criteria for cervical spine injuries. Ann Emerg Med 16:738-42	Y / N / Y / Y	749 consecutive trauma patients who had C-spine x-rays, 5 views. 2.4% incidence of clinically significant spine injuries. No asymptomatic fractures were identified.
Davis JW	1993	The etiology of missed cervical spine injuries. J Trauma 34:342-6	Y / N / Y / Y	32,117 consecutive trauma patients who had 3 views + CT, MRI as needed. 2.3% incidence of spine injuries. There was a delay or missed diagnosis in 31/34 due to inadequate or misread films, and 0.01% incidence of "occult" injury.
Davis JW	1995	Clearing the cervical spine in obtunded patients: The use of dynamic fluoroscopy. J Trauma 39:435-8	Y / Y / Y / Y	Prospective study of 116 consecutive head injured patients with GCS<14 (mean=8.1) for more than 48 hrs and normal 3 views who underwent flex/ex fluoroscopic evaluations.
First Author	Year	Reference Title	Compliance in the 4 Quality Categories Defined study pop / Prospective / Who looked at films / What studies	Conclusions
Domeier RM	1996	Mechanism of injury is not a factor in prehospital clinical evaluation of potential spine injury. [Abstract] Prehospital Disaster Med 11:114	Y / Y / N / N	Prospective study of 6500 consecutive trauma patients to determine the importance of mechanism of injury in predicting spine fracture. 3.3% incidence of spine injuries. Mechanism of injury was not as important as other clinical risk factors.
Domeier RM	1995	Prospective validation of prehospital spinal clearance criteria. [Abstract] Acad Emerg Med 2:335	N / Y / N / N	Prospective study of 2000 consecutive trauma patients for evaluation of prehospital risk factors as predictors of spine injury. 3% incidence of spine injuries. No unstable injuries were identified in absence of prehospital risk factors.
Fischer RP	1984	Cervical radiographic evaluation of alert patients following blunt trauma. Ann Emerg Med 13:905-7	Y / N / N / N	226 consecutive alert trauma patients who had C-spine x-rays. 2.2% had spine fractures. No fractures in asymptomatic patients.
Freemyer B	1989	Comparison of five-view and three-view cervical spine series in the evaluation of patients with cervical trauma. Ann Emerg Med 18:818-21	Y / Y / Y / Y	Prospective study of 58 consecutive high-risk trauma patients comparing 3-view vs 5-view plain x-rays and confirmation of fracture with CT. No improvement in detection of injuries with addition of oblique views when compared with standard 3 views.
Hoffman JR	1992	Low-risk criteria for cervical-spine radiography in blunt trauma: A prospective study. Ann Emerg Med 21:1454-60	Y / Y / Y / Y	Prospective study of 974 consecutive trauma patients to identify specific risk factors. Patients had 3 views + CT, obliques, flex/ex as needed. 208% incidence of spine injuries. All had neck pain, intoxication, altered mental status, or distracting pain elsewhere.
Jacobs LM	1986	Prospective analysis of acute cervical spine injury: A methodology to predict injury. Ann Emerg Med 15:44-9	Y / Y / Y / Y	Prospective study of 233 consecutive trauma patients to determine physiciansí ability to predict spine injury via AP and lateral views. 7% incidence of clinically significant injuries. Physician judgement was accurate only 50% of the time.
First Author	Year	Reference Title	Compliance in the 4 Quality Categories Defined study pop / Prospective / Who looked at films / What studies	Conclusions
Jergens ME	1977	Selective use of radiography of the skull and cervical spine. West Med J 127:1-4	Y / Y / N / N	Prospective study of 573 consecutive trauma patients to determine incidence of asymptomatic injuries. 1.2% incidence of spine injuries. No patient was asymptomatic.
Kirshenbaum KJ	1990	Unsuspected upper cervical spine fractures associated with significant head trauma: Role of CT. J Emerg Med 8:183-98	Y / Y / Y / Y	Prospective study of 50 consecutive trauma patients. 4/50 had C-1,2 fractures not seen on plain 3-view x-rays. All 4 had intracranial hemorrhage.
Kreipke DL	1989	Reliability of indications for cervical spine films in trauma patients. J Trauma 29:1438-9	Y / Y / Y / Y	Prospective study of 860 consecutive trauma patients to determine reliability of clinical symptoms in predicting injury. 2.8% incidence of spine injuries. Noninjuries in asymptomatic patients.
McNamara RM	1988	Post-traumatic neck pain: A prospective and follow-up study. Ann Emerg Med 17:906-11	Y / N / Y / N	286 consecutive trauma patients for reliability of clinical symptoms in predicting injury. 2% incidence of spine injury, none in asymptomatic patients.
Neifeld GL	1988	Cervical injury in head trauma. J Emerg Med 6:203-7	Y / Y / Y / Y	Prospective study of 886 trauma patients. 3.16% incidence of fractures, none in asymptomatic patients.
Rachesky I	1987	Clinical prediction of cervical spine injuries in children. Am J Dis Child 141:199-201	Y / N / Y / N	2133 consecutive pediatric trauma patients. 1.2% incidence of spine injuries. All had neck pain or were in MVA with associated head trauma.
Reid DC	1987	Etiology and clinical course of missed spine fractures. J Trauma 27:980-6	Y / Y / N / N	Of 253 consecutive trauma patients with spine injuries, 23% had delay in diagnosis of injury due to failure to obtain x-rays, misread x-rays, altered LOC, multiple injuries, 2 level c-spine injuries.
First Author	Year	Reference Title	Compliance in the 4 Quality Categories Defined study pop / Prospective / Who looked at films / What studies	Conclusions
Ringenberg BJ	1988	Rational ordering of cervical spine radiographs following trauma. Ann Emerg Med 17:792-6	Y / N / N / N	312 consecutive hospitalized trauma patients. No asymptomatic patient had cervical spine injury. 7.4% delay in diagnosis due to failure to obtain x-ray or misread x-ray.
Roberge RJ	1988	Selective application of cervical spine radiography in alert victims of blunt trauma: A prospective study. J Trauma 28:784-8	Y / Y / Y / Y	Prospective study of 467 consecutive trauma patients. 1.7% incidence of spine injuries. No asymptomatic patient had injuries,
Ross SE	1987	Clearing the cervical spine: Initial radiologic evaluation. J Trauma 27:1055-60	Y / Y / Y / Y	Prospective study of 204 consecutive trauma patients with single lateral vs 3-views vs CT in evaluation of injuries. 6% incidence of spine injuries. If technically adequate, 3-views had 100% negative predictive value and were superior to CT or single lateral x-ray.
Schleehauf K	1989	Computed tomography in the initial evaluation of the cervical spine. Ann Emerg Med 18:815-7	Y / Y / Y / Y	Prospective study of 104 consecutive trauma patients. 5% incidence of spine injuries. CT alone missed 1 injury seen on plain films.
Williams J	1992	Head, facial, and clavicular trauma as a predictor of cervical-spine injury. Ann Emerg Med 21:719-22	Y / N / N / N	5021 consecutive trauma patients and reliability of clinical symptoms in predicting injury. 4.5% incidence of spine injuries. Head or facial injuries were not independent risk factors but GCS<14 was, 6.7% vs 3.9%.