You are faced with a decision as to how to best treat and diagnose the patient. Radiology questions the evidence supporting CT as first-line imaging for non-low risk cervical neck trauma imaging. Plain radiology is experiencing some back up issues so the charge nurse asks you to CT his head and neck together “just to get it done”. When you apply the clinical rules, you quickly discover that the patient is not low risk on either count and will require imaging of both his head and c-spine.
The charge nurse, aware of the recent departmental push to limit costs, asks if the patient can be cleared based on c-spine and head injury clinical decision rules. The patient has a normal neurological exam. Your primary and secondary surveys only reveal the cranial injury described above and some paraspinal tenderness from cervical vertebrate 2-4. His daughter reports that her father has hypertension and arthritis for which he sporadically takes Aleve as needed. The patient complains of a left parietal headache with midline cervical neck pain. As per your local EMS protocol, he arrived on a backboard wearing a cervical collar. His Glascow Coma Scale has been 15 since the time of his injury. He was found by his daughter shortly after the fall who reported that her father was awake but disoriented without any reported loss of consciousness or emesis. Apparently, he tripped while walking down his basement steps and has a large boggy contusion to his left parietal area. The final article is identified by reviewing the meta-analysis.Īn 86 year old male presents to your ED via EMS after a fall from standing. Search Strategy: You search PUBMED using Clinical Queries )] and obtain three of the articles selected below among 51 “hits”. CT versus X-ray for Cervical Spine Blunt Trauma