Compliance With NICE Guidance for Cervical Spine Trauma Imaging: A Single Centre Retrospective Evaluation

INTRODUCTION: In 2016 the National Institute for Health and Care Excellence (NICE) published guidance in England recommending computed tomography (CT) as the first line imaging for cervical spine (C-spine) injury in adults. However anecdotal evidence suggests that X-rays are still being performed. The aim of this evaluation was to determine the imaging referral patterns following C-spine trauma and compare with national guidance. METHODS: Within a single English organisation emergency department patient attendance data, X-ray and CT referral criteria and acquisition information for patients ≥ 16 years undergoing imaging of the C-spine was collated from a 12-month period (01.01.23-31.12.23). RESULTS: The cohort contained 302 females and 301 males, with a median age of 55 years. According to the clinical information 12.1% (n = 73/603) of the patients had no risk of C-spine injury and therefore should not have required diagnostic imaging. Almost two thirds of patients (n = 395/603; 65.5%) had first line CT imaging consistent with national guidance. Of those where imaging was justified, 135 patients had the incorrect initial diagnostic test (X-ray as opposed to CT) with 26 also having a subsequent CT. The quality of all of the X-rays were reviewed and only 39.5% (n = 73/185) of cases were diagnostic. CONCLUSIONS: In 2023, the organisation was 65.5% compliant with the guidance, with a number of patients referred for unjustified imaging examinations and/or the wrong initial imaging modality. The consequences of this included treatment delays, prolonged immobilisation, over-irradiation and impact upon resources, along with potentially missed pathology due to inconclusive X-rays.