Accuracy of plain radiography in cervical spine injury

Background and Objectives: Routine clinical examination and plain radiography are reportedly inadequate for the determination of cervical injury. Accordingly, it is required to perform computed tomography (CT) scan on the cervical spine in suspected trauma cases, even in those with normal clinical examination findings. However, the risk of radiation and financial charges should be also considered in these cases. Therefore, the present study was conducted to compare the accuracy of plain radiography with that of CT (a gold standard) in the evaluation of cervical spine injury. Materials and Methods: This diagnostic study was conducted on 220 trauma patients (the mean age of 38.25 ± 5.13 years) referred to the Emergency Department of Besat Hospital, Hamadan, Iran, from April 2019 to March 2020. The patients with the National Emergency X-Radiography Utilization Study low-risk criteria underwent CT and plain radiography. Results: According to the results, 210 (95.5%) patients were normal in both imaging modalities. Out of 10 patients with abnormal CT, four patients were detected by the plain radiography. Therefore, the plain radiography had the sensitivity, specificity, negative predictive value, and positive predictive value of 40%, 100%, 97.2%, and 100%, respectively. Conclusions: As the findings indicated, plain radiography was inadequate for the definite exclusion of cervical spine injury. Therefore, this modality should be considered only in low-risk patients. On the other hand, patients with moderate and high probability of injuries need to undergo a CT scan as the only and first screening imaging modality. However, a low-dose CT scan is a preferred protocol for this group of patients.