Flexion-extension cervical spine radiography in blunt trauma: A survey of emergency physicians

Abstract

A survey investigating the use of flexion-extension cervical spine radiography (FE CSR) was distributed to emergency medicine physicians (EMPs). 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. One hundred forty-four surveys (58%) were returned. Sixty-six percent of the EMPs were emergency medicine residency-trained, and 38% of the respondents had less than 5 years of clinical experience. Practice settings included emergency departments with an annual volume of >40,000 patients (50%), community-based hospitals (66%), and level I trauma centers (41%). Eighty-seven percent of EMPs obtained FE CSR in 20% of blunt trauma patients with neck complaints. 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%). 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%). With normal FE CSR, 27% would use additional studies: computed tomography (CT) (56%), oblique view (19%); and magnetic resonance imaging (MRI) (7%). EMPs reported that they did not accompany the patient in 52% of cases. The consultant physician recommended FE CSR in 71% (radiology consultation) and 41% (orthopedic or neurosurgical consultation) of cases, respectively. EMPs used FE CSR in a significant minority of blunt trauma patients along with other radiographic imaging modalities. Reasons for ordering FE CSR more often included radiographic abnormalities rather than historical or examination findings. Consultants frequently recommended their use. FE CSRs were performed most often without physician supervision.