C-spine clearance should not be a pain in the neck

In the UK, neck injury from blunt trauma is not an uncommon presentation in the emergency department (ED). However, the incidence of actual c-spine injury is low. Nevertheless, the majority of patients who present with blunt trauma neck pain are usually referred for radiography. It has been argued that this cautious approach is justified because of the potentially catastrophic consequences that may occur, should such an injury be misdiagnosed.

A prospective observational study, conducted over 24 months in two UK EDs, aimed to examine whether using the Canadian Cervical Spine Rule (CCR) could safely reduce the number of unnecessary c-spine radiographs undertaken in patients presenting with acute blunt neck trauma. In total, 148 doctors (including Senior House Officer grade through to consultants) were trained in the use of the CCR.

They were asked to assess eligible patients who had potential c-spine injuries using the CCR, but manage and treat them according to current practice. The doctors were also asked to rate their confidence in the CCR.