Consistent evidence was found to support the use of ' red flags ' to screen for serious pathologies , judicious use of imaging through clinical decision rule application and promotion of functional exercise coupled with advice and reassurance .
Neck pain and whiplash injuries are a common presentation to the ED , and a frequent cause of disability globally .
This rapid review investigated best practice for the assessment and management of musculoskeletal neck pain in the ED .
Clinical clearance of the cervical spine in patients with distracting injuries: It is time to dispel the myth
OBJECTIVE The purpose of this study was to prospect ively assess the sensitivity and efficacy of clinical examination for screening of cervical spine ( c-spine ) injury in awake and alert blunt trauma patients with concomitant “ distracting injuries . ” METHODS During the 24-month period from December 2009 to December 2011 , all blunt trauma patients older than 13 years were prospect ively evaluated with a st and ard cervical spine examination protocol by the trauma surgery team at a Level 1 trauma center . Awake and alert patients with a Glasgow Coma Score ( GCS ) ≥14 underwent clinical examination of the cervical spine . Clinical examination was performed regardless of “ distracting injuries . ” Patients without complaints of pain or tenderness on physical exam had their cervical collar removed , and the c-spine was considered clinical ly cleared of injury . All awake and alert patients with “ distracting injuries , ” including those clinical ly cleared and those with complaints of c-spine pain or tenderness underwent computerized tomographic ( CT ) scanning of the entire c-spine . “ Distracting injuries ” were categorized into three anatomic regions : head injuries , torso injuries and long bone fractures . Patients with minor distracting injuries were not considered to have a “ distracting injury . ” RESULTS During the 24-month study period , 761 blunt trauma patients with GCS ≥14 and at least one “ distracting injury ” had been entered into the study protocol . Two-hundred ninety-six ( 39 % ) of the patients with “ distracting injuries ” had a positive c-spine clinical examination , 85 ( 29 % ) of whom were diagnosed with c-spine injury . Four hundred sixty-four ( 61 % ) of the patients with “ distracting injuries ” were initially clinical ly cleared , with one patient ( 0.2 % ) diagnosed with a c-spine injury . This yielded an overall sensitivity of 99 % ( 85/86 ) and negative predictive value greater than 99 % ( 463/464 ) for cervical spine clinical examination in awake and alert blunt trauma patients with “ distracting injuries . ” CONCLUSIONS In the awake and alert blunt trauma patient with “ distracting injuries , ” clinical examination is a sensitive screening method for cervical spine injury . Radiological assessment is unnecessary for safe clearance of the asymptomatic cervical spine in awake and alert blunt trauma patients with “ distracting injuries . ” These findings suggest the concept of “ distracting injury ” in the context of cervical spine clinical examination is invalid . Exp and ing the utility of cervical spine clinical examination to patients with “ distracting injuries ” allows for significant reduction of both healthcare cost and radiation exposure . LEVEL OF EVIDENCE Diagnostic study , level
Consistent evidence was found to support the use of ' red flags ' to screen for serious pathologies , judicious use of imaging through clinical decision rule application and promotion of functional exercise coupled with advice and reassurance .
Neck pain and whiplash injuries are a common presentation to the ED , and a frequent cause of disability globally .
This rapid review investigated best practice for the assessment and management of musculoskeletal neck pain in the ED .