Evidence-based imaging evaluation of the cervical spine in trauma

Despite the relatively low frequency of cervical spine fractures in trauma patients, tremendous resources are expended on the use of imaging to exclude fracture. Current evidence indicates that simple clinical criteria, such as the National Emergency X-Radiography Utilization Study or NEXUS criteria or Canadian cervical spine prediction rule, can be used to exclude fracture safely without imaging in many low-risk subjects. In high-risk subjects, cost-effectiveness analysis suggests that CT is the preferred initial strategy. Appropriate high-risk subjects can be selected for imaging with CT using the Harborview high-risk cervical spine criteria. An evidence-based approach to cervical spine imaging in trauma is presented.