84 The Impact of a Cervical Spine Radiographic Protocol on Cost and Prophylactic Spinal Immobilization SGA Gabram, RJ Schwartz, LM Jacobs/Hartford Hospital, University of Connecticut School of Medicine, Hartford A prospective cohort study was conducted to determine the impact of a protocol for the radiographic evaluation of the cervical spine of blunt-injured patients. All admitted blunt trauma patients with suspected injury to the cervical spine were entered into the study. Data on patients were collected two months prior (75) and two months after protocol (68). The protocol eliminated routine oblique views and instituted earlier computed tomography (CT) scanning of the odontoid if open-mouth Water's views were unobtainable. Data elements included age, mechanism of injury, Injury Severity Score (ISS), Glasgow Coma Scale (GCS), number of days of spinal collar immobilization, diagnoses related to cervical spine injuries, radiograph-related charges, and initial physical examination results. The two groups were not statistically different in age, GCS, ISS, and number intubated. Three patients in the preprotocol group had confirmed (CT scan) spinal injuries; there were none in the after protocol group. The range of days patients were immobilized was one to 11 (mean, t.87) for the prior group and one to four (mean, 1.2) for the after group (P = .003). For those patients whose initial physical and radiographic examinations were suggestive of an injury, the number of days for cervical collar immobilization decreased from 5.2 days in the prior group to 1.8 days in the after group (P = .01). Intubated patients decreased from 4.1 days to 1.6 days (P = .009). Cervical spine-related radiograph charges decreased from $8,782 (mean, $117) to $6,679 (mean, $98) (P = .079). The use of a predetermined protocol for evaluating the cervical spine in blunt trauma can decrease the number of days of cervical spine immobilization and decrease radiograph-related charges.