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.

Should all patients with blunt trauma undergo 'routine' pelvic X-ray?

Routine pelvic radiography is carried out in all blunt trauma patients referred to our Emergency Department according to advanced trauma life support protocols. In this retrospective study, we questioned whether it is cost-effective to obtain 'routine' pelvic X-ray films. The notes and X-rays of all consecutive patients with blunt trauma who were referred to the Emergency Department of Dokuz Eylül University Hospital, Izmir, Turkey, between August and December, 1993 were re-evaluated. Eighteen patients who were unconscious and/or intoxicated and/or not fully orientated were excluded from the study. The remaining 65 patients were divided into three groups according to whether they were complaining of pain and whether pain was present on pelvic examination; group A consisted of those complaining of pain who also had pelvic pain on examination (28 patients), group B consisted of those complaining of pain or who had pain on pelvic examination (four patients) and group C consisted of those with no history of pain and no pain on pelvic examination (33 patients). Among the 65 patients whose pelvic X-rays were evaluated, 14 (22%) cases were shown to have fracture and all of these patients belonged to group A. The remaining 51 (78%) patients revealed no fractures. The difference between the groups were statistically significant (p < 0.001). As a result, we concluded that 'routine' pelvic radiography should be performed in the setting of blunt trauma only if the patient is: (a) unconscious, uncooperative or intoxicated, or (b) conscious, fully orientated and cooperative and complaining of pain both in the history and on pelvic examination. These limitations would allow us to decrease the amount of irradiation received, render more cost-effective treatment, and reduce the workload of emergency and radiology departments.