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 .
Prospective performance assessment of an out-of-hospital protocol for selective spine immobilization using clinical spine clearance criteria.
STUDY OBJECTIVE We determine whether the use of an emergency medical services ( EMS ) protocol for selective spine immobilization would result in appropriate immobilization without spinal cord injury associated with nonimmobilization . METHODS A 4-year prospect i ve study examined EMS and hospital records for patients after the implementation of an EMS protocol for selective spine immobilization .  EMS personnel were trained to perform and document a spine injury assessment for out-of-hospital trauma patients with a mechanism of injury judged sufficient to cause a spine injury . The assessment included these clinical criteria : altered mental status , evidence of intoxication , neurologic deficit , suspected extremity fracture , and spine pain or tenderness . The protocol required immobilization for patients with a positive assessment on any of those criteria . Outcome characteristics included the presence or absence of spine injury and spine injury management . RESULTS The study collected data on 13,483 patients ; 126 of the patients were subsequently excluded from the study because of incomplete data , leaving a study sample of 13,357 patients with complete data .  Spine injuries were confirmed in the hospital records for 3 % ( n=415 ) of patients , including 50 patients with cord injuries and 128 patients with cervical injuries . Sensitivity of the EMS protocol was 92 % ( 95 % confidence interval [ CI ] 89.4 to 94.6 % ) result ing in nonimmobilization of 8 % of the patients with spine injuries ( 33 of 415 ) . None of the nonimmobilized patients sustained cord injuries . The specificity was 40 % ( 95 % CI 38.9 to 40.5 % ) . CONCLUSION The use of our selective immobilization protocol result ed in spine immobilization for most patients with spine injury without causing harm in cases in which spine immobilization was withheld
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 .