Can emergency physicians accurately rule out clinically important cervical spine injuries by using computed tomography?. Issue 2 (4th March 2015)

• Record Type: Journal Article
• Authors: Van Zyl, Hendrik P.; Bilbey, James; Vukusic, Alan; Ring, Todd; Oakes, Jennifer; Williamson, Lykke D.; Mitchell, Ian V.
• Is Part Of: CJEM. Volume 16:Issue 2(2014:Mar.)
• Page Start: 131
• Page End: 135
• Publication Date: 2015-03-04
• Subjects: cervical spine injury, -- computed tomography, -- emergency physician, -- sensitivity, -- trauma; Emergency Treatment -- Periodicals; Emergency Medicine -- Periodicals; Emergency medical services -- Canada -- Periodicals; Medical emergencies -- Canada -- Periodicals; Emergency medical services; Medical emergencies; Canada; Periodicals; 616.02505
• DOI: 10.2310/8000.2013.130978
• Languages: English
• ISSNs: 1481-8035

Abstract

ABSTRACT: Objective: Emergency physicians are expected to rule out clinically important cervical spine injuries using clinical skills and imaging. Our objective was to determine whether emergency physicians could accurately rule out clinically important cervical spine injuries using computed tomographic (CT) imaging of the cervical spine. Method: Fifteen emergency physicians were enrolled to interpret a sample of 50 cervical spine CT scans in a nonclinical setting. The sample contained a 30% incidence of cervical spine injury. After a 2-hour review session, the participants interpreted the CT scans and categorized them into either a suspected cervical spine injury or no cervical spine injury. Participants were asked to specify the location and type of injury. The gold standard interpretation was the combined opinion of two staff radiologists. Results: Emergency physicians correctly identified 182 of the 210 abnormal cases with cervical spine injury. The sensitivity of emergency physicians was 87% (95% confidence interval [CI] 82–91), and the specificity was 76% (95% CI 74–77). The negative likelihood ratio was 0.18 (95% CI 0.12–0.25). Conclusion: Experienced emergency physicians successfully identified a large proportion of cervical spine injuries on CT; however, they were not sufficiently sensitive to accurately exclude clinically important injuries. Emergency physicians should rely on a radiologist review of cervical spine CT scans prior to discontinuing cervical spine precautions.