E1840. Clinical Indications for Cervical Spine Computed Tomography and Incidence of Cervical Spine Injuries: A 12-Month Audit in a Tertiary Centre
Sir Charles Gairdner Hospital
Trauma to the cervical spine can be associated with major spinal cord injuries, and failure to diagnose ligamentous or osseous injuries can result in significant mortality and morbidity. 54% of all traumatic spinal cord injuries are a result of direct trauma to the cervical spine in Australia. Approximately 2% of cervical spine injuries are clinically important injuries including fractures, dislocations and ligamentous instability.
A number of guidelines have been published to aid clinicians in assessing patients with potential cervical spinal injuries, including the National Emergency X-Radiography Utilisation Study (NEXUS) criteria and Canadian C-spine rule. Both tools are generally used in conjunction with one another for the recommendation of imaging and to exclude clinically significant cervical spine injuries. Although originally used for the recommendation of plain radiography, it is now internationally recognised that the optimal imaging modality for the detection of cervical spine injury is computed tomography (CT). The use of clinical decision-making tools has been reported to reduce the overall imaging rates of blunt cervical trauma. Yet, despite these measures to reduce inappropriate imaging and increase the general diagnostic yield of imaging a patient, it appears that the number of cervical spine CT performed are increasing and are often reported as normal.
This audit aims to investigate if the cervical spine computed tomography (CT) performed in our tertiary hospital are clinically indicated as per the NEXUS criteria or Canadian C spine rule, and the incidence of cervical spine injuries detected on CT.
Materials and Methods:
A retrospective audit was conducted on patients who have received a CT cervical spine over a 12-month period, between the 1st of July 2018 to 30th of June 2019 inclusive, from Sir Charles Gairdner Hospital in Western Australia. The clinical indications provided on the request forms were noted if they met any of the conditions of the NEXUS criteria or Canadian C-spine rule.
A total of 1285 cervical spine CT were performed. Of these 95.5% of the studies had a relevant clinical indication provided on the request form. 8.2% of the requests did not have a relevant indication for a CT cervical spine provided. A total of 4.4% of these CTs performed were found to be positive, with approximately 5% of these cases not having a clinical indication provided on the request form.
Results of the study show that most referrals for CT cervical spines after blunt cervical spine trauma are appropriate. Despite the high compliance with guidelines and decision-making tools, the yield for cervical spine injuries in cervical spine CT is extremely low. There is significant room for improvement to maximise clinical detection of cervical spine injuries and reduction in unnecessary imaging.