Screening protocol s have high predictive values to detect cervical spine fracture in alert , low-risk patients seeking emergency care after blunt neck trauma .
Computerized tomography ( CT ) scans had better validity ( in adults and elderly ) than radiographs in assessing high-risk and /or multi-injured blunt trauma neck patients .
In the absence of serious pathology , clinical physical examinations are more predictive at excluding than confirming structural lesions causing neurologic compression .
One exception is the manual provocation test for cervical radiculopathy , which has high positive predictive value .
There was no evidence that specific MRI findings are associated with neck pain , cervicogenic headache , or whiplash exposure .
No evidence supports using cervical provocative discography , anesthetic facet , or medial branch blocks in evaluating neck pain .
Reliable and valid self-report question naires are useful in assessing pain , function , disability , and psychosocial status in individuals with neck pain .
CONCLUSION The scientific evidence supports screening protocol s in emergency care for low-risk patients ; and CT-scans for high-risk patients with blunt trauma to the neck .
In nonemergency neck pain without radiculopathy , the validity of most commonly used objective tests is lacking .
OBJECTIVE To critically appraise and synthesize the literature on assessment of  neck pain .
SUMMARY OF BACKGROUND DATA The published literature on assessment of neck pain is large and of variable quality .
There have been no prior systematic review s of this literature .
Low-risk criteria for cervical-spine radiography in blunt trauma: a prospective study.
STUDY HYPOTHESIS Cervical-spine radiography does not need to be performed on selected blunt trauma patients who are awake , alert , nonintoxicated , do not complain of midline neck pain , and have no tenderness over the bony cervical spine . STUDY POPULATION One thous and consecutive patients seen in the UCLA Emergency Medicine Center with a chief complaint of blunt trauma , for whom cervical-spine films were ordered and for whom prospect i ve data question naires were completed . METHODS Clinicians completed data forms for each patient before radiograph results were known . Data items included mechanism of injury , evidence of intoxication , presence of cervical-spine pain and /or tenderness , level of alertness , presence of focal neurologic deficits , and presence of other severely painful injuries unrelated to the cervical spine . Physicians were also asked to estimate likelihood of significant cervical-spine injury . RESULTS 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 . CONCLUSION 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
Screening protocol s have high predictive values to detect cervical spine fracture in alert , low-risk patients seeking emergency care after blunt neck trauma .
Computerized tomography ( CT ) scans had better validity ( in adults and elderly ) than radiographs in assessing high-risk and /or multi-injured blunt trauma neck patients .
In the absence of serious pathology , clinical physical examinations are more predictive at excluding than confirming structural lesions causing neurologic compression .
One exception is the manual provocation test for cervical radiculopathy , which has high positive predictive value .
There was no evidence that specific MRI findings are associated with neck pain , cervicogenic headache , or whiplash exposure .
No evidence supports using cervical provocative discography , anesthetic facet , or medial branch blocks in evaluating neck pain .
Reliable and valid self-report question naires are useful in assessing pain , function , disability , and psychosocial status in individuals with neck pain .
CONCLUSION The scientific evidence supports screening protocol s in emergency care for low-risk patients ; and CT-scans for high-risk patients with blunt trauma to the neck .
In nonemergency neck pain without radiculopathy , the validity of most commonly used objective tests is lacking .
OBJECTIVE To critically appraise and synthesize the literature on assessment of  neck pain .
SUMMARY OF BACKGROUND DATA The published literature on assessment of neck pain is large and of variable quality .
There have been no prior systematic review s of this literature .