Inagaki et al proposed a clinical decision rule for when to order a cervical CT scan in a patient with trauma to the head or neck. Use of the rule can reduce unnecessary testing. The authors are from the Center Hospital of the National Center of Global Health and Medicine (Tokyo) and Seirei Hamamatsu General Hospital in Japan.

Patient selection: head or neck trauma


A cervical CT scan should be ordered if:

(1) the Glasgow coma score <= 13

(2) there is posterior cervical tenderness

(3) there is a neurological deficit

(4) trauma was associated with fall down stairs

(5) trauma was associated with fall from height

(6) trauma was associated with a motorcycle accident


If none of the factors are present then a cervical CT scan may not need to be performed.



• The sensitivity was 100% and specificity 52% in the study group.


NOTE: There may be need to modify this for certain situations. For example, an INR >= 1.5 is associated with an increased risk for cervical epidural hematoma.

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