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 .
Test performance of the individual NEXUS low-risk clinical screening criteria for cervical spine injury.
BACKGROUND The National Emergency X-Radiography Utilization Study ( NEXUS ) recently vali date d the ability of a decision instrument to define a population with an extremely low risk of cervical spine injury ( CSI ) after blunt trauma . It is unclear whether each of the 5 individual criteria is necessary for the decision instrument to maintain its high sensitivity . METHODS NEXUS was a prospect i ve observational study at 21 emergency departments , which enrolled all patients with blunt trauma for whom cervical spine radiographs were ordered . In this sub study , we examined the NEXUS data base to determine the contribution of each of the 5 individual low-risk clinical criteria to the overall sensitivity of the decision instrument . RESULTS All but 8 of 818 patients with CSI , and all but 2 of 578 patients with significant CSI , were identified by using the decision instrument . A substantial number of patients with CSI ( 236/818 [ 29 % ] ) and patients with significant CSI ( 175/578 [ 30 % ] ) met only 1 of the 5 non -- low-risk criteria , and each of the 5 criteria was the only indicator of non -- low-risk status in at least 8 patients with CSI and at least 5 patients with significant CSI . CONCLUSION Because each of the 5 low-risk criteria was the only marker of non -- low-risk status in at least a few patients with significant CSI , modification of the overall NEXUS decision instrument by eliminating any one of the criteria would markedly reduce sensitivity and make the instrument unacceptable for clinical use
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 .