Low Yield of Paired Head and Cervical Spine Computed Tomography in Blunt Trauma Evaluation

Publication date: June 2018
Source:The Journal of Emergency Medicine, Volume 54, Issue 6
Author(s): Joseph Graterol, Maria Beylin, William D. Whetstone, Ashleigh Matzoll, Rennie Burke, Jason Talbott, Robert M. Rodriguez
BackgroundWith increased computed tomography (CT) utilization, clinicians may simultaneously order head and neck CT scans, even when injury is suspected only in one region.ObjectiveWe sought to determine: 1) the frequency of simultaneous ordering of a head CT scan when a neck CT scan is ordered; 2) the yields of simultaneously ordered head and neck CT scans for clinically significant injury (CSI); and 3) whether injury in one region is associated with a higher rate of injury in the other.MethodsThis was a retrospective study of all adult patients who received neck CT scans (and simultaneously ordered head CT scans) as part of their blunt trauma evaluation at an urban level 1 trauma center in 2013. An expert panel determined CSI of head and neck injuries. We defined yield as number of patients with injury/number of patients who had a CT scan.ResultsOf 3223 patients who met inclusion criteria, 2888 (89.6%) had simultaneously ordered head and neck CT scans. CT yield for CSI in both the head and neck was 0.5% (95% confidence interval [CI] 0.3–0.8%), and the yield for any injury in both the head and neck was 1.4% (95% CI 1.0–1.8%). The yield for CSI in one region was higher when CSI was seen in the other region.ConclusionsThe yield of CT for CSI in both the head and neck concomitantly is very low. When injury is seen in one region, there is higher likelihood of injury in the other. These findings argue against paired ordering of head and neck CT scans and suggest that CT scans should be ordered individually or when injury is detected in one region.



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