{"id":761,"date":"2014-01-30T22:24:16","date_gmt":"2014-01-30T22:24:16","guid":{"rendered":"http:\/\/drcrunch.wordpress.com\/?p=761"},"modified":"2014-01-30T22:24:16","modified_gmt":"2014-01-30T22:24:16","slug":"nice-guidelines-for-cervical-spine-imaging-2014","status":"publish","type":"post","link":"http:\/\/drcrunch.co.uk\/blog\/2014\/01\/30\/nice-guidelines-for-cervical-spine-imaging-2014\/","title":{"rendered":"NICE Guidelines for Cervical Spine Imaging 2014"},"content":{"rendered":"<p>There I was reading \u201cAccident and Emergency Radiology\u201d by Harvey and finding out how to interpret a cervical spine xrays when I discovered that the <a href=\"http:\/\/pathways.nice.org.uk\/pathways\/head-injury#path=view%3A\/pathways\/head-injury\/investigation-for-injuries-to-the-cervical-spine-in-patients-with-head-injury.xml&amp;content=close\" target=\"_blank\">NICE guidelines on CT Imaging in Head Trauma<\/a> had completely changed. For starters, it seems to imply that if anyone is good enough for the CT Head following traumatic brain injury, then they are also good enough for a cervical spine CT.<\/p>\n<p><b>Who gets a cervical spine CT?<\/b><\/p>\n<ul>\n<li>GCS &lt; 13 on initial assessment.<\/li>\n<li>The patient has been intubated.<\/li>\n<li>Xrays are abnormal, unclear or inadequate <i>&#8211; this could mean that the swimmer\u2019s view will become a thing of the past, as it was done for making C7\/T1 junctions more apparent when not well visualised. Now it seems you move straight to CT cervical spine. <\/i><\/li>\n<li>A definitive diagnosis of cervical spine injury is needed urgently (for example, before surgery).<\/li>\n<li>The patient is having other body areas scanned for head injury or multi-region trauma <i>\u2013 ? all patients getting a CT Head for head injury<\/i><\/li>\n<\/ul>\n<p>Also, if the patient is alert and stable, there is clinical suspicion of cervical spine injury and any of the following apply:<\/p>\n<ol>\n<li>age 65 years or older<\/li>\n<li>dangerous mechanism of injury (fall from a height of greater than 1 metre or 5 stairs; axial load to the head, for example, diving; high-speed motor vehicle collision; rollover motor accident; ejection from a motor vehicle; accident involving motorised recreational vehicles; bicycle collision)<\/li>\n<li>focal peripheral neurological deficit (including paraesthesia in the upper or lower limbs).<\/li>\n<\/ol>\n<p>Those last three seem lifted straight from the Canadian C Spine rule.<\/p>\n<p><b>Who can be cleared clinically?<\/b><\/p>\n<p>People who don\u2019t meet CT cervical spine criteria AND have at least one of the following:<\/p>\n<ol>\n<li>was involved in a simple rear-end motor vehicle collision<\/li>\n<li>is comfortable in a sitting position in the emergency department<\/li>\n<li>has been ambulatory at any time since injury<\/li>\n<li>has no midline cervical spine tenderness<\/li>\n<li>presents with delayed onset of neck pain.<\/li>\n<\/ol>\n<p>According to NICE, if they can then actively rotate their neck 45 degrees to the left and right, that clears the C-spine.<\/p>\n<p><b>What is the role of cervical xrays?<\/b><\/p>\n<p>Those who don\u2019t meet CT cervical spine criteria AND cannot be cleared clinically (either failing to be cleared clinically, or not having one of the 5 factors above that permit attempting to clear the c-spine clinically) should have 3 view C=spine xrays.<\/p>\n<p><b>What&#8217;s this all based on?<\/b><\/p>\n<p>It closely follows the <a href=\"http:\/\/www.racgp.org.au\/afp\/2012\/april\/cervical-spine\/\" target=\"_blank\">Canadian C Spine<\/a> rules:<\/p>\n<figure id=\"attachment_762\" aria-describedby=\"caption-attachment-762\" style=\"width: 474px\" class=\"wp-caption alignnone\"><a href=\"https:\/\/i0.wp.com\/drcrunch.co.uk\/blog\/wp-content\/uploads\/2014\/01\/c-spine-canadian.gif\"><img loading=\"lazy\" decoding=\"async\" data-attachment-id=\"762\" data-permalink=\"http:\/\/drcrunch.co.uk\/blog\/2014\/01\/30\/nice-guidelines-for-cervical-spine-imaging-2014\/c-spine-canadian\/\" data-orig-file=\"https:\/\/i0.wp.com\/drcrunch.co.uk\/blog\/wp-content\/uploads\/2014\/01\/c-spine-canadian.gif?fit=587%2C620\" data-orig-size=\"587,620\" data-comments-opened=\"1\" data-image-meta=\"{&quot;aperture&quot;:&quot;0&quot;,&quot;credit&quot;:&quot;&quot;,&quot;camera&quot;:&quot;&quot;,&quot;caption&quot;:&quot;&quot;,&quot;created_timestamp&quot;:&quot;0&quot;,&quot;copyright&quot;:&quot;&quot;,&quot;focal_length&quot;:&quot;0&quot;,&quot;iso&quot;:&quot;0&quot;,&quot;shutter_speed&quot;:&quot;0&quot;,&quot;title&quot;:&quot;&quot;,&quot;orientation&quot;:&quot;0&quot;}\" data-image-title=\"c spine canadian\" data-image-description=\"&lt;p&gt;From http:\/\/www.racgp.org.au\/afp\/2012\/april\/cervical-spine\/&lt;\/p&gt;\n\" data-medium-file=\"https:\/\/i0.wp.com\/drcrunch.co.uk\/blog\/wp-content\/uploads\/2014\/01\/c-spine-canadian.gif?fit=284%2C300\" data-large-file=\"https:\/\/i0.wp.com\/drcrunch.co.uk\/blog\/wp-content\/uploads\/2014\/01\/c-spine-canadian.gif?fit=587%2C620\" class=\"size-large wp-image-762\" alt=\"C Spine\" src=\"https:\/\/i0.wp.com\/drcrunch.co.uk\/blog\/wp-content\/uploads\/2014\/01\/c-spine-canadian.gif?resize=474%2C500\" width=\"474\" height=\"500\" data-recalc-dims=\"1\" \/><\/a><figcaption id=\"caption-attachment-762\" class=\"wp-caption-text\">The C Spine rules from Canada<\/figcaption><\/figure>\n","protected":false},"excerpt":{"rendered":"<p>There I was reading \u201cAccident and Emergency Radiology\u201d by Harvey and finding out how to interpret a cervical spine xrays when I discovered that the NICE guidelines on CT Imaging&#8230;<\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"spay_email":"","footnotes":"","jetpack_publicize_message":""},"categories":[2],"tags":[36,47,48,58,111,150,229,234],"class_list":["post-761","post","type-post","status-publish","format-standard","hentry","category-medical-education","tag-c-spine","tag-clear","tag-clinically-clear","tag-ct","tag-imaging","tag-nice","tag-when-to","tag-xrays"],"jetpack_featured_media_url":"","jetpack_publicize_connections":[],"jetpack_sharing_enabled":true,"jetpack_shortlink":"https:\/\/wp.me\/p9zRNY-ch","jetpack_likes_enabled":true,"jetpack-related-posts":[],"_links":{"self":[{"href":"http:\/\/drcrunch.co.uk\/blog\/wp-json\/wp\/v2\/posts\/761","targetHints":{"allow":["GET"]}}],"collection":[{"href":"http:\/\/drcrunch.co.uk\/blog\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"http:\/\/drcrunch.co.uk\/blog\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"http:\/\/drcrunch.co.uk\/blog\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"http:\/\/drcrunch.co.uk\/blog\/wp-json\/wp\/v2\/comments?post=761"}],"version-history":[{"count":0,"href":"http:\/\/drcrunch.co.uk\/blog\/wp-json\/wp\/v2\/posts\/761\/revisions"}],"wp:attachment":[{"href":"http:\/\/drcrunch.co.uk\/blog\/wp-json\/wp\/v2\/media?parent=761"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"http:\/\/drcrunch.co.uk\/blog\/wp-json\/wp\/v2\/categories?post=761"},{"taxonomy":"post_tag","embeddable":true,"href":"http:\/\/drcrunch.co.uk\/blog\/wp-json\/wp\/v2\/tags?post=761"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}