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Use of diagnostic imaging in the emergency department for cervical spine injuries in Kingston, Ontario

  • William Pickett (a1) (a2), Atif Kukaswadia (a2), Wendy Thompson (a3), Mylene Frechette (a3), Steven McFaull (a3), Hilary Dowdall (a2) and Robert J. Brison (a1) (a2)...

Abstract

Objectives:

This study assessed the use and clinical yield of diagnostic imaging (radiography, computed tomography, and medical resonance imaging) ordered to assist in the diagnosis of acute neck injuries presenting to emergency departments (EDs) in Kingston, Ontario, from 2002–2003 to 2009–2010.

Methods:

Acute neck injury cases were identified using records from the Kingston sites of the Canadian National Ambulatory Care Reporting System. Use of radiography was analyzed over time and related to proportions of cases diagnosed with clinically significant cervical spine injuries.

Results:

A total of 4,712 neck injury cases were identified. Proportions of cases referred for diagnostic imaging to the neck varied significantly over time, from 30.4% in 2002–2003 to 37.6% in 2009–2010 (ptrend = 0.02). The percentage of total cases that were positive for clinically significant cervical spine injury (“clinical yield”) also varied from a low of 5.8% in 2005–2006 to 9.2% in 2008–2009 (ptrend = 0.04), although the clinical yield of neck-imaged cases did not increase across the study years (ptrend = 0.23). Increased clinical yield was not observed in association with higher neck imaging rates whether that yield was expressed as a percentage of total cases positive for clinically significant injury (p = 0.29) or as a percentage of neck-imaged cases that were positive (p = 0.77).

Conclusions:

We observed increases in the use of diagnostic images over time, reflecting a need to reinforce an existing clinical decision rule for cervical spine radiography. Temporal increases in the clinical yield for total cases may suggest a changing case mix or more judicious use of advanced types of diagnostic imaging.

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Copyright

Corresponding author

Emergency Medicine Research, Queen’s University, Angada 3, Kingston General Hospital, 76 Stuart Street, Kingston, ON K7L 2V7; will.pickett@queensu.ca

References

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1.Stiell, IG, Wells, GA, Vandemheen, KL, et al. The Canadian C-Spine Rule for radiography in alert and stable trauma patients. JAMA 2001;286:1841–8, doi:10.1001/jama.286.15.1841.
2.Stiell, IG, Clement, CM, Grimshaw, J, et al. Implementation of the Canadian C-Spine Rule: prospective 12 centre cluster randomized trial. BMJ 2009;339:b4146, doi:10.1136/bmj.b4146.
3.Public Health Agency of Canada. Canadian Hospitals Injury Reporting and Prevention Program (CHIRPP). Available at: (accessed June 13, 2010).
4.Dowdall, H, Gee, M, Brison, RJ, et al. Utilization of radiographs for the diagnosis of ankle fractures in Kingston, Ontario, Canada. Acad Emerg Med 2011;18:555–8, doi:10.1111/j.1553-2712.2011.01058.x. [Epub 2011May 5]
5.Gibson, D, Richards, H, Chapman, A.The National Ambulatory Care Reporting System: factors that affect the quality of its emergency data. Int J Inform Qual 2008;2:97114, doi:10.1504/IJIQ.2008.022958.
6.Canadian Institute for Health Information. Data quality documentation for external users: National Ambulatory Care Reporting System, 2010–2011. Toronto: Canadian Institute for Health Information, Standards and Data Submission; 2011.
7.World Health Organization. International classification of diseases and related health problems. 10th revision. Geneva: World Health Organization; 1992.
8.Molony, TW, Rogers, DE.Medical technology—a different view of the contentious debate over costs. N Engl J Med 1979;301:1413–9, doi:10.1056/NEJM197912273012603.
9.Stiell, I, Wells, G, Laupacis, A, et al. Multicentre trial to introduce the Ottawa Ankle rules for use of radiography in acute ankle injuries. BMJ 1995;311:5947, doi:10.1136/bmj.311.7005.594.
10.Stiell, IG, Wells, GA, Vandemheen, K, et al. The Canadian CT Head Rule for patients with minor head injury. Lancet 2001;357:1391–6, doi:10.1016/S0140-6736(00)04561-X.
11.Stiell, IG, Bennett, C.Implementation of clinical decision rules in the emergency department. Acad Emerg Med 2007;14:955–9. [Epub 2007 Oct 8]
12.Stiell, IG, Clement, CM, McKnight, RD, et al. The Canadian C-Spine Rule versus the NEXUS Low-Risk Criteria in patients with trauma. N Engl J Med 2003;349:2510–8, doi:10.1056/NEJMoa031375.
13.Stiell, IG, Grimshaw, J, Wells, GA, et al. A matched-pair cluster design study protocol to evaluate implementation of the Canadian C-spine rule in hospital emergency departments: Phase III. Implement Sci 2007;2:4, doi:10.1186/1748-5908-2-4.
14.Bandiera, G, Stiell, IG, Wells, GA, et al. The Canadian CSpine Rule performs better than unstructured physician judgement. Ann Emerg Med 2003;42:395402, doi:10.1016/S0196-0644(03)00422-0.
15.Kerr, D, Bradshaw, L, Kelly, A.Implementation of the Canadian C-Spine Rule reduces cervical spine x-ray rate for alert patients with potential neck injury. J Emerg Med 2005;28:127–31, doi:10.1016/j.jemermed.2004.08.016.
16.Logan, JO, Graham, ID.Toward a comprehensive interdisciplinary model of health care research use. Sci Commun 1998;20:227–46, doi:10.1177/1075547098020002004.
17.Drummond, AJ.No room at the inn: overcrowding in Ontario’s emergency departments. CJEM 2002;4:91–7.
18.Graham, ID, Stiell, IG, Laupacis, A, et al. Awareness and use of the Ottawa ankle and knee rules in 5 countries: can publication alone be enough to change practice? Ann Emerg Med 2001;37:259–66, doi:10.1067/mem.2001.113506.

Keywords

Use of diagnostic imaging in the emergency department for cervical spine injuries in Kingston, Ontario

  • William Pickett (a1) (a2), Atif Kukaswadia (a2), Wendy Thompson (a3), Mylene Frechette (a3), Steven McFaull (a3), Hilary Dowdall (a2) and Robert J. Brison (a1) (a2)...

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