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 .
The Canadian C-spine rule for radiography in alert and stable trauma patients.
CONTEXT High levels of variation and inefficiency exist in current clinical practice regarding use of cervical spine ( C-spine ) radiography in alert and stable trauma patients . OBJECTIVE To derive a clinical decision rule that is highly sensitive for detecting acute C-spine injury and will allow emergency department ( ED ) physicians to be more selective in use of radiography in alert and stable trauma patients . DESIGN Prospect i ve cohort study conducted from October 1996 to April 1999 , in which physicians evaluated patients for 20 st and ardized clinical findings prior to radiography .  In some cases , a second physician performed independent interobserver assessment s. SETTING Ten EDs in large Canadian community and university hospitals . PATIENTS Convenience sample of 8924 adults ( mean age , 37 years ) who presented to the ED with blunt trauma to the head/neck , stable vital signs , and a Glasgow Coma Scale score of 15 . MAIN OUTCOME MEASURE Clinical ly important C-spine injury , evaluated by plain radiography , computed tomography , and a structured follow-up telephone interview .  The clinical decision rule was derived using the kappa coefficient , logistic regression analysis , and chi(2 ) recursive partitioning techniques . RESULTS Among the study sample , 151 ( 1.7 % ) had important C-spine injury . The result ant model and final Canadian C-Spine Rule comprises 3 main questions : ( 1 ) is there any high-risk factor present that m and ates radiography ( ie , age > /=65 years , dangerous mechanism , or paresthesias in extremities ) ? ( 2 ) is there any low-risk factor present that allows safe assessment of range of motion ( ie , simple rear-end motor vehicle collision , sitting position in ED , ambulatory at any time since injury , delayed onset of neck pain , or absence of midline C-spine tenderness ) ? and ( 3 ) is the patient able to actively rotate neck 45 degrees to the left and right ? By cross-validation , this rule had 100 % sensitivity ( 95 % confidence interval [ CI ] , 98%-100 % ) and 42.5 % specificity ( 95 % CI , 40%-44 % ) for identifying 151 clinical ly important C-spine injuries . The potential radiography ordering rate would be 58.2 % . CONCLUSION We have derived the Canadian C-Spine Rule , a highly sensitive decision rule for use of C-spine radiography in alert and stable trauma patients . If prospect ively vali date d in other cohorts , this rule has the potential to significantly reduce practice variation and inefficiency in ED use of C-spine radiography
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 .