Are cervical spine X-rays mandatory in all blunt trauma patients?

Traumatic cervical spine injuries can result in severe disability or death unless promptly diagnosed and treated. Advanced trauma life support guidelines recommend that three-view cervical spine X-rays should be obtained routinely in all blunt trauma patients. In this retrospective study, we evaluated whether cervical spine X-rays are indeed necessary in all such patients. The study comprised those patients who were conscious, fully orientated, co-operative and non-intoxicated. Among the 303 blunt trauma patients seen at our emergency department between January and December 1993, a total of 267 patients had well-written charts and met our inclusion criteria. Thirteen (5%) patients who complained of neck pain or had neck tenderness on initial examination were found to harbour cervical spine injuries. Of those patients sustaining cervical spine injuries, examination of three (23%) disclosed abnormal neurological findings. On the other hand, none of the patients without neck pain and tenderness were found to have cervical spine injury. We conclude that pain and/or tenderness in the neck area are valid criteria with regard to the timely diagnosis of cervical spine injuries, and that routine cervical spine X-rays may be unnecessary for those blunt trauma patients who are conscious, fully orientated, co-operative, non-intoxicated, exhibit no neurological deficits and who do not have neck pain or tenderness. Omitting cervical X-rays speeds up patient evaluation, protects the department staff from unnecessary exposure to ionizing radiation and mitigates treatment costs, while maintaining the quality of the healthcare provided.