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 .
Retrospective application of the NEXUS low-risk criteria for cervical spine radiography in Canadian emergency departments.
STUDY OBJECTIVE We evaluate the accuracy , reliability , and potential impact of the National Emergency X-Radiography Utilization Study ( NEXUS ) low-risk criteria for cervical spine radiography , when applied in Canadian emergency departments ( EDs ) . METHODS The Canadian C-Spine Rule derivation study was a prospect i ve cohort study conducted in 10 Canadian EDs that recruited alert and stable adult trauma patients . Physicians completed a 20-item data form for each patient and performed interobserver assessment s when feasible . The prospect i ve assessment s included the 5 individual NEXUS criteria but not an explicit interpretation of the overall need for radiography according to the criteria . Patients underwent plain radiography , flexion-extension views , and computed tomography at the discretion of the treating physician .  Patients who did not have radiography  were followed up with a structured outcome assessment by telephone to determine clinical ly important cervical spine injury , a previously vali date d outcome measurement . Analyses included sensitivity and specificity with 95 % confidence interval ( CI ) , kappa coefficient , and potential radiography rates . RESULTS Among 8,924 patients , 151 ( 1.7 % ) patients had an important cervical spine injury . The combined NEXUS criteria identified important cervical spine injury with a sensitivity of 92.7 % ( 95 % CI 87 % to 96 % ) and a specificity of 37.8 % ( 95 % CI 37 % to 39 % ) . Application of the NEXUS criteria would have potentially reduced cervical spine radiography rates by 6.1 % from the actual rate of 68.9 % to 62.8 % . Of 11 patients with important injuries not identified , 2 were treated with internal fixation and 3 with a halo . CONCLUSION This retrospective validation found the NEXUS low-risk criteria to be less sensitive than previously reported . The NEXUS low-risk criteria should be further explicitly and prospect ively evaluated for accuracy and reliability before widespread clinical use outside of the United States
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 .