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. 2023 Sep;24(5):967-973.
doi: 10.5811/westjem.58948.

Factors Associated with Overutilization of Computed Tomography of the Cervical Spine

Karl T Chamberlin  1 , Maureen M Canellas  2 , Martin A Reznek  2 , Kevin A Kotkowski  2
Affiliations

Factors Associated with Overutilization of Computed Tomography of the Cervical Spine

Karl T Chamberlin et al. West J Emerg Med. 2023 Sep.

Abstract

Introduction: Despite the wide availability of clinical decision rules for imaging of the cervical spine after a traumatic injury (eg, NEXUS C-spine rule and Canadian C-spine rule), there is significant overutilization of computed tomography (CT) imaging in patients who are deemed to be at low risk for a clinically significant cervical spine injury by these clinical decision rules. The purpose of this study was to identify the major factors associated with the overuse of CT cervical spine imaging using a logistic regression model. Methods: This was a retrospective review of all adult patients who underwent CT cervical spine imaging for evaluation of a traumatic injury at a tertiary academic emergency department (ED) and three affiliate community EDs in January and February 2019. We performed multivariable logistic regression to identify factors associated with obtaining CT cervical spine imaging despite low-risk classification by the NEXUS C-spine Rule. Results: A total of 1,051 patients underwent CT cervical spine imaging for traumatic indications during the study period, and 889 patients were included in the analysis. Of these patients, 376 (42.3%) were negative by the NEXUS C-spine rule. Variables that were associated with increased likelihood of unnecessary imaging included age over 65, Emergency Severity Index (ESI) score 2 and 3, arrival as a walk-in, and anticoagulation status. Patients who presented to the tertiary academic ED had a significantly lower likelihood of unnecessary imaging. Twenty-one patients (2.4%) were found to have cervical spine fractures on imaging, two of whom were negative by the NEXUS C-spine rule, but neither had a clinically significant fracture. Conclusion: Cervical spine imaging is vastly overused in patients presenting to the ED with traumatic injuries, as adjudicated using the NEXUS C-spine rule as a reference standard. Older age, ESI level, arrival as a walk-in, and taking anticoagulation drugs were associated with overutilization of CT imaging. Conversely, presenting to the tertiary academic ED was associated with a lower likelihood of undergoing unnecessary imaging. This model can guide future interventions to optimize ED CT utilization and minimize unnecessary testing.

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Conflict of interest statement

Conflicts of Interest: By the WestJEM article submission agreement, all authors are required to disclose all affiliations, funding sources and financial or management relationships that could be perceived as potential sources of bias. No author has professional or financial relationships with any companies that are relevant to this study. There are no conflicts of interest or sources of funding to declare.

Figures

Figure 1.
Figure 1.
Of the 1,051 computed tomography C-spine studies performed in the study period, 889 met inclusion criteria. Forty-two percent of the studies were performed on NEXUS-negative patients, and none of the NEXUS-negative patients were found to have a clinically significant cervical spine injury.
See this image and copyright information in PMC

References

    1. Cairns C, Kang K. National Hospital Ambulatory Medical Care Survey: 2019 Emergency Department Summary Tables. Hyattsville, Maryland: National Center for Health Statistics; 2022.
    1. Inaba K, Byerly S, Bush LD, et al. . Cervical spinal clearance: a prospective Western Trauma Association multi-institutional trial. J Trauma Acute Care Surg. 2016;81(6):1122–30. - PMC - PubMed
    1. Hasler RM, Exadaktylos AK, Bouamra O, et al. . Epidemiology and predictors of cervical spine injury in adult major trauma patients: a multicenter cohort study. J Trauma Acute Care Surg. 2012;72(4):975–81. - PubMed
    1. Milby AH, Halpern CH, Guo W, et al. . Prevalence of cervical spinal injury in trauma. Neurosurg Focus. 2008;25(5):E10. - PubMed
    1. Young AJ, Wolfe L, Tinkoff G, et al. . Assessing incidence and risk factors of cervical spine injury in blunt trauma patients using the National Trauma Data Bank. Am Surg. 2015;81(9):879–83. - PubMed