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 .
Validity of a set of clinical criteria to rule out injury to the cervical spine in patients with blunt trauma. National Emergency X-Radiography Utilization Study Group.
BACKGROUND Because clinicians fear missing occult cervical-spine injuries , they obtain cervical radiographs for nearly all patients who present with blunt trauma . Previous research suggests that a set of clinical criteria ( decision instrument ) can identify patients who have an extremely low probability of injury and who consequently have no need for imaging studies . METHODS We conducted a prospect i ve , observational study of such a decision instrument at 21 centers across the United States . The decision instrument required patients to meet five criteria in order to be classified as having a low probability of injury : no midline cervical tenderness , no focal neurologic deficit , normal alertness , no intoxication , and no painful , distracting injury . We examined the performance of the decision rule in 34,069 patients who underwent radiography of the cervical spine after blunt trauma . RESULTS The decision instrument identified all but 8 of the 818 patients who had cervical-spine injury ( sensitivity , 99.0 percent [ 95 percent confidence interval , 98.0 to 99.6 percent ] ) . The negative predictive value was 99.8 percent ( 95 percent confidence interval , 99.6 to 100 percent ) , the specificity was 12.9 percent , and the positive predictive value was 2.7 percent . Only two of the patients classified as unlikely to have an injury according to the decision instrument met the preset definition of a clinical ly significant injury ( sensitivity , 99.6 percent [ 95 percent confidence interval , 98.6 to 100 percent ] ; negative predictive value , 99.9 percent [ 95 percent confidence interval , 99.8 to 100 percent ] ; specificity , 12.9 percent ; positive predictive value , 1.9 percent ) , and only one of these two patients received surgical treatment . According to the results of assessment with the decision instrument , radiographic imaging could have been avoided in the cases of 4309 ( 12.6 percent ) of the 34,069 evaluated patients . CONCLUSIONS A simple decision instrument based on clinical criteria can help physicians to identify reliably the patients who need radiography of the cervical spine after blunt trauma . Application of this instrument could reduce the use of imaging in such patients
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 .