Hockberger RS, Kirshenbaum KJ, Doris Peter E. Appropriateness criteria for imaging and treatment decisions. J Bone Joint Surg Br 1976 58:322–7.Īmerican College of Radiology Task Force on Appropriateness Criteria. Hidden flexion injury of the cervical spine. Webb JK, Broughton RBK, McSweeney T, et al. Anterior cervical subluxation: an unstable position. Evaluation of the cervical spine in whiplash injuries. Moderately severe whiplash injuries of the cervical spine and their roentgenologic diagnosis. The use of flexion-extension cervical spine radiography in pediatric blunt trauma. Ann Emerg Med 1997 30:406.īrady WJ, Pollock G, Young J, Kini N, DeBehnke D. Flexion-extension cervical spine radiography in adult blunt trauma. Ann Emerg Med 1991 20:117–21.īrady WJ, Moghtader J, Young JS, et al. Flexion-extension views in the evaluation of cervical spine injuries. Lewis LM, Docherty M, Ruoff BE, Fortney JP, Keltner RA, Britton P. Recommendations for evaluation of the acutely injured cervical spine: a clinical radiologic algorithm. FE CSRs were performed most often without physician supervision. Consultants frequently recommended their use. Reasons for ordering FE CSR more often included radiographic abnormalities rather than historical or examination findings. EMPs used FE CSR in a significant minority of blunt trauma patients along with other radiographic imaging modalities. The consultant physician recommended FE CSR in 71% (radiology consultation) and 41% (orthopedic or neurosurgical consultation) of cases, respectively. With normal FE CSR, 27% would use additional studies: computed tomography (CT) (56%), oblique view (19%) and magnetic resonance imaging (MRI) (7%).ĮMPs reported that they did not accompany the patient in 52% of cases. Contraindications to FE CSR were altered mentation (91%), focal neurologic issue (88%), distracting injury (71%), non-English speaker (50%), and young age (defined as <6 years) (29%). Indications for FE CSR were minimal disruption of cervical contour lines (68%), posterior element interval widening (53%), tenderness (49%), pain (45%), soft tissue swelling (38%), and mechanism of injury (34%). Practice settings included emergency departments with an annual volume of >40,000 patients (50%), community-based hospitals (66%), and level I trauma centers (41%).Įighty-seven percent of EMPs obtained FE CSR in 20% of blunt trauma patients with neck complaints. Sixty-six percent of the EMPs were emergency medicine residency-trained, and 38% of the respondents had less than 5 years of clinical experience. One hundred forty-four surveys (58%) were returned. A 20-point survey was mailed to EMPs (N=250) randomly chosen from the membership of the American College of Emergency Physicians in the United States and Canada. A survey investigating the use of flexion-extension cervical spine radiography (FE CSR) was distributed to emergency medicine physicians (EMPs).
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