Greater adherence to accepted criteria could reduce unnecessary cervical spine CT scans

Physicians can avoid exposing patients to unnecessary CT scans and amounts of radiation by more closely following guidelines to identify cervical spine injuries, according to researchers at Henry Ford Hospital in Detroit.

“While imaging testing is an important aspect of patient care, we have to make sure that these tests are ordered appropriately,” Brent D. Griffith, MD, lead study author and chief resident of radiology at the hospital, stated in a Henry Ford Health System press release. “With an emphasis nationally on decreasing radiation exposure and improving the use of health care resources, it is important that both radiologists and clinicians address the appropriate use of all imaging tools.”

Brent D. Griffith

Griffith and colleagues conducted a multiphase study to determine whether application of the National Emergency X-Radiology Study (NEXUS) criteria would result in fewer imaging tests in patients who sustained blunt trauma. According to the press release, the criteria notes that patients who are less likely to have a cervical spine injury will present with a normal level of alertness and have no evidence of intoxication, focal neurological defects, painful distracting injuries tenderness or tenderness at the middle of the neckline.

According to the study abstract, the investigators discovered that 24% of 1,524 cervical spine CT scans performed in the setting of blunt trauma between January and December 2008 at a level 1 trauma center may have been unnecessary, as a retrospective review showed they had “no documentation of any of the five NEXUS low-risk criteria.” The second phase of the study, which included a collaborative prospective analysis of blunt trauma patients who underwent cervical spine CTs, found that 16% of 502 CT scans were potentially unnecessary. Phase 3 of the study involved an educational program for physicians about the NEXUS criteria. Early results showed an improved, but not statistically significant, reduction in unnecessary tests using the criteria.

Reference:

Griffith B. Screening cervical spine CT in the emergency department: a collaborative multi-phase approach to imaging over-utilization. Presented at: Radiological Society of North America Scientific Assembly and Annual Meeting; Nov. 25-30, 2012; Chicago.

Disclosure: This study was funded by the Henry Ford Hospital. One of the authors (Jain) received research support from General Electric.