CT selection for cervical‑spine injury after head injury/trauma
Concise guidance for emergency clinicians on when to request CT of the cervical spine after head injury or other trauma. This section follows NICE recommendations (NG232, NG41), which adopt the Canadian C‑Spine Rule for adults (≥16 years). Operational standards (timing, reporting, dose optimisation) and paediatric differences are emphasised.
Why this matters
- Missed cervical‑spine (C‑spine) injury can cause permanent neurological disability, and CT has the best sensitivity for clinically important fractures.
- Unnecessary CT exposes patients-especially children-to ionising radiation. Use validated decision rules and local protocols to balance risk and benefit (NICE NG232, NG41).
Adults (≥16 years): use the Canadian C‑Spine Rule (NICE NG232)
Apply the rule in sequence: 1. If any high‑risk feature is present, CT cervical spine is indicated. 2. If no high‑risk features but one or more low‑risk features are present, assess active neck rotation 45° each way; inability to do so indicates CT. 3. If no high‑risk features and no low‑risk features are present, CT is indicated.
High‑risk features (any one → CT)
- Age ≥65 years.
- Dangerous mechanism, for example:
- fall from height (e.g. ≥3 ft / 5 stairs),
- axial load to the head such as diving,
- high‑speed motor vehicle collision,
- ejection/rollover,
- bicycle collision.
- Paresthesiae in the extremities.