Carolinas Core Concepts Core Concepts in EM; a repository for Carolinas lecture summaries.


C-Spine Imaging in the ED

  • In low-risk groups with an adequate c-spine XRay, the negative predictive value is 99.9%.   However, C-spine XRay sensitivity for all comers is only 36-64% and average time-to-dispo is 1.9 hours vs 1 hour on average for CT.
  • CT c-spine disadvantages:  Cancer risk 1:200 in 15 y/o, 1:2,000 in 30 y/o, 1:5,000 in 70 y/o.  Cost is also higher, although when inadequate CSXR and "missed fracture" costs are added in they may be comparable.
  • In the alert patient with a negative CT c-spine but persistent bony tenderness there are three options: continue collar upon discharge, MRI for ligamentous injury, or flex-extension films.