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 .
Outcomes at 12 Months After Early Magnetic Resonance Imaging in Acute Trauma Patients With Persistent Midline Cervical Tenderness and Negative Computed Tomography
Study Design . A prospect i ve observational cohort study of alert , neurologically intact trauma patients presenting to the emergency department with midline cervical tenderness . Screening cervical magnetic resonance imaging ( MRI ) had been conducted after negative computed tomography ( CT ) when tenderness was persistent . Objective . To determine the association of acute findings and demographic characteristics with any long-term neck disability , and with time to return to work in such patients . Summary of Background Data . The relationship between acute findings and outcomes in these patients is unknown , and we hypothesized that outcomes at 12 months would correlate with acute clinical signs and symptoms , MRI findings , and mechanisms of injury . Methods . Patients at a Level 1 trauma center with persistent midline cervical tenderness in the absence of evidence of intoxication , painful distracting injury , persistently abnormal neurology , or acute CT findings , who underwent early cervical MRI under the institutional protocol , were review ed in the outpatient spine clinic after discharge . In addition , the factors associated with neck disability and time to return to work were examined at follow-up at 12 months after presentation . Results . There were 162 of 178 patients available for follow-up at 12 months ( 91 % ) . Of these , 46 % had MRI-identified cervical spine injury at their initial examination , and 22 % had required clinical management , including 2.5 % with operative stabilization . Neck disability was present in 43 % of patients and was associated with depressive symptoms , workers ' compensation , and low annual income . Delay in return to work was associated with the presence of minor limb/other fractures and depressive symptoms , whereas patients on high annual incomes were found to return to work more quickly . Conclusion . Surprisingly in these acute trauma patients , MRI-detected injury , clinical factors , and injury mechanism were not found to be associated with long-term patient outcomes . As a result , a trial of a more targeted , individual return to work plan , including strategies aim ed at improving physical and psychological function , may now be justified to optimize long-term recovery , reduce health re source costs , and maximize economic productivity through early return to work
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 .