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 decision rule to reduce cervical spine radiography in elderly patients with blunt trauma.
STUDY OBJECTIVES A decision instrument based on 5 clinical criteria has been shown to be highly sensitive in selecting patients who require cervical spine imaging after blunt trauma , while simultaneously reducing overall imaging . We examine the performance of this instrument in the elderly and explore some of the common features of geriatric cervical spine injury ( CSI ) .  METHODS The National Emergency X-radiography Utilization Study ( NEXUS ) was a prospect i ve , observational , multicenter study conducted at 21 geographically diverse centers . We analyzed the performance of the NEXUS decision instrument among patients at least 65 years of age . RESULTS The study group consisted of 2,943 ( 8.6 % ) geriatric patients , representing 8.6 % of the entire NEXUS sample . The rate of CSI was twice as great in these patients as it was in nongeriatric patients ( 4.59 % versus 2.19 % ) . Odontoid fractures were particularly common in geriatric patients , accounting for 20 % of geriatric fractures compared with 5 % of nongeriatric fractures . The frequency of patients meeting NEXUS criteria was similar in the 2 groups , with 14 % of geriatric patients and 12.5 % of nongeriatric patient classified as low risk . CSI occurred in only 2 low-risk geriatric patients , and these patients ' injuries met our preset definition of a clinical ly insignificant injury . The sensitivity of the NEXUS decision instrument for clinical ly significant injury in the geriatric group was therefore 100 % ( 95 % confidence interval 97.1 % to 100 % ) . CONCLUSION The prevalence of CSI , and especially odontoid fracture , is relatively increased among geriatric patients with blunt trauma . The NEXUS decision instrument can be applied safely to these patients , with an expected reduction in cervical imaging comparable with that achieved in nongeriatric 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 .