Abstract
Introduction: Of the many cases of cervical trauma, a small number of lesions are important, and
therefore, in more than 98% of spinal imaging, no positive finding is observed. Moreover, evidence
suggests the high frequency of requested radiographs for neck trauma in patients with multiple trauma.
Objectives: The aim of the study was to evaluate the results of radiographic assessment and CT
scanning of cervical injuries in patients with multiple trauma with painful distracting injuries. We
also determine the concordance between need for imaging assessment and referring the patients by
physicians for imaging.
Patients and Methods: The study population included 244 multiple trauma patients presenting with or
without painful distracting injury (PDI) and referred to one of the three general governmental hospitals
in Tehran. All patients required neck radiologic evaluation according to Nexus criteria.
Results: Of the 244 patients under study, 68.8% had PDI and 31.2% had no PDI. The most of the
damages associated with distracting injury were limb fractures and laceration or soft tissue damage.
In total, 14 of 244 patients (5.7%) with cervical trauma suffered cervical fracture of which 6 cases
(42.9%) had PDI that of those, the presence of PDI was the only known Nexus index for radiological
assessment of the cervical spine only in 2 (14.3%). In 6 patients out of 14 with cervical fractures, the
painful distracting injuries included limb fractures in 3 patients, laceration or soft tissue damage in 2
patients, and visceral injuries in 1 patient. Thus, of 14 patients with cervical neck fractures, 8 had no
painful distracting injuries and 6 had painful distracting injuries.
Conclusion: A few patients with PDI – as an indication for cervical radiography – had cervical spine
injuries. Therefore, the exploitation of the NEXUS criteria, especially PDI, cannot be a very precise
and specific for requesting cervical radiography.