Imaging after trauma to the neck

doi:10.1136/bmj.39433.663715.BE

BMJ 2008;336:154-157 (19 January), doi:10.1136/bmj.39433.663715.BE

Practice

Rational Imaging

Imaging after trauma to the neck

Bernard Wee, specialist registrar¹, John H Reynolds, consultant radiologist¹, Anthony Bleetman, consultant in emergency medicine²

¹ Department of Radiology, Heart of England NHS Foundation Trust, Birmingham Heartlands Hospital, Birmingham, B9 5SS, ² Department of Emergency Medicine, Heart of England NHS Foundation Trust

Correspondence to: J H Reynolds john.reynolds@heartofengland.nhs.uk

Plain radiography is often used to image the neck after trauma,but computed tomography and magnetic resonance imaging providefurther useful information and should be considered

The first 150 words of the full text of this article appear below.

A 53 year old woman presented to the emergency department afterfalling down a flight of stairs several hours before. She hadsevere neck pain but was alert and orientated; she had a scoreof 15 on the Glasgow coma scale. A neurological and systemicexamination identified no significant findings.

Decisions about imaging should be based on careful clinicalassessment of the patient and knowledge of the mechanism ofinjury. Two evidence based guidelines—the Canadian cervicalspine rules¹ ² (box 1) and the NEXUS (national emergency x radiographyutilization study) rules³ (box 2; fig 1)—are useful decisionmaking tools.

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Fig 1 The Canadian cervical spine rule

Age $≥$ 65 years, dangerous mechanism of injury, orparaesthesia in extremities

Adangerous mechanism of injury is considered to be a fall froma height of at least a metre or five stairs; an axial load tothe head (for example, during diving); a motor . . . [Full text of this article]

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