Simple falls, assaults don't require cervical spine CT

Emergency department physicians should skip the CT scans for patients who show up after a simple fistfight assault or ground-level fall, researchers said on Thursday at the 2012 American Roentgen Ray Society (ARRS) meeting in Vancouver.

The criteria for cervical spine imaging can be vague, often leading to unnecessary CT exams and unnecessary radiation, said lead author Dr. Andrew Nicholson, from the Emory University School of Medicine in Atlanta. The number of cervical spine CT scans for trauma has risen 241% in the past seven years at the institution, but acute pathology remains rare, he said.

The researchers identified two indications with a low probability of fracture or cervical spine dislocation: ground-level fall and assault with a fist. The retrospective review examined a year's worth of spine CT exams associated with one of these indications, categorizing each case as acute traumatic process, positive, or equivocal.

The 294 cases included 194 ground-level falls and 100 assaults with a fist. The ground-level fall category included three equivocal CT exams and two positive exams. Both patients who were positive at CT had a prior diagnosis of ankylosing spondylitis, conferring an increased pretest probability of spine fracture. No patients in the "assault" category had a positive exam.

Absent a known disposition to cervical spine fracture, the authors believe that patients with one or two fracture indications should not have a workup that includes CT. Even if the pretest probability is ignored, the rate of positive studies would be less than 1%, Nicholson said.

The notion of identifying situations likely to yield negative CT results, and thus not performing scans, could potentially reduce the frequency of unnecessary exams in several applications, the authors reported.