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MINERVA ORTOPEDICA E TRAUMATOLOGICA
A Journal on Orthopedics and Traumatology
Minerva Ortopedica e Traumatologica 2015 February;66(1):1-8
Routine radiological evaluation in emergency departments after cervical spine trauma: necessary diagnostics or habits?
Bistolfi A. 1, Cerrato M. 2, Gaido C. 2, Carnino I. 2, Federico A. M. 2, Massazza G. 1, 2
1 Department of Orthopedics, Traumatology and Rehabilitation, CTO Hospital, Città della Salute e della Scienza Turin, Italy;
2 School of Rehabilitation, University of Turin, Turin, Italy
AIM: In emergency units, cervical spine X-ray (C-Rx) is frequently used for head and neck traumas very often resulting in “negative for fractures”. Also, in most of the patients without neurological deficits, the exam results negative for clinically serious lesions. This review discusses the role of the clinical decision rules in reducing the unnecessary cervical spine imaging exams.
METHODS: Research in the literature about the indications to perform C-Rx after whiplash injury (head and neck trauma) with the following key-words: cervical spine and radiography; cervical spine trauma; cervical spine injury AND nexus; cervical spine AND canadian C-spine rule in the last 10 years.
RESULTS: Validated guidelines about this topic are not available. To reduce the number of C-Rx after soft traumas, the application of clinical scales has been proposed. The validated scales are the NEXUS and the Canadian C-Spine rule (CCR). They can identify with high sensitivity the cases in which C-Rx is useless. Concerning major traumas (traumas with the presence of high energy or neurological deficit symptoms) C-Rx is recommended to find out clinically important injuries: fracture, dislocation, ligament instability.
CONCLUSION: A regulamentation in the use of the C-Rx would create advantages for the patients and for the health facilities. The working out of specific guide lines is recommended. The approbation of the single Hospitals and guidelines from the Scientific Societies is essential to avoid legal issues and controversies.