Hoffman AEM 1998 – Pre-NEXUS study

Short Citation: Ann Emerg Med;21(12):1454-60.

PubMed PMID: 1443841

Full Citation: Hoffman JR, Schriger DL, Mower W, Luo JS, Zucker M. Low-risk criteria for cervical-spine radiography in blunt trauma: a prospective study. Ann Emerg Med;21(12):1454-60.

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Study Size: 1000

Findings: Twenty-seven patients with cervical-spine fracture were among the 974 patients for whom data forms were completed. A number of findings were statistically more common in the group of patients with fracture than without, but no single or paired findings identified all patients with fracture. All 27 patients with fracture had at least one of the following four characteristics: midline neck tenderness, evidence of intoxication, altered level of alertness, or a severely painful injury elsewhere. Three hundred fifty-three of 947 (37.3%) patients without cervical-spine fracture had none of these findings.

Authors' Conclusions: Cervical-spine radiology may not be necessary in patients without spinous tenderness in the neck, intoxication, altered level of alertness, or other severely painful injury. A policy to limit films in such patients would have decreased film ordering by more than one third in this series, while identifying all patients with fracture.

Additional comments from Journal Gems contributors: This is the precursor study for the larger NEXUS study published in NEJM 2000.

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