Original Contributions| Volume 64, ISSUE 2, P121-128, February 2023

Frequency and Outcomes of Cervical Spine Computed Tomography Imaging on Alcohol-Intoxicated Patients in the Emergency Department

Published:November 16, 2022DOI:



      Cervical spinal (c-spine) injuries range greatly in severity from minor ligamentous injuries to osteoligamentous instability with spinal cord injuries. Initial evaluation begins with stabilization as needed and immediate immobilization. Current practice as to whether the c-spine can be cleared clinically without radiographic evaluation is often guided by using the National Emergency X-Radiography Utilization Study Low-Risk Criteria and the Canadian C-Spine Rule. Under these clinical decision guidelines, stable trauma patients presenting with alcohol intoxication cannot have the c-spine cleared clinically and imaging should be “considered.”


      This study aimed to assess the frequency of computed tomography (CT) c-spine scans ordered for patients presenting with alcohol intoxication to the emergency department (ED), the timing of the studies, and subsequently determine the proportion of which showed a clinically significant result that required intervention.


      In this retrospective medical record review, all clinically alcohol-intoxicated patients presenting to two academic EDs were included. Overall demographic characteristics, time to order of CT imaging, radiology reads, and outcomes of patient visits were determined.


      There were 8008 patient visits included in the study. Of these visits, 5 patients scanned in ≤3 h had acute findings on CT scan and no patients with a deferred timing of CT scan after patients metabolized had an acute finding on CT scan. No patients required operative management.


      This study's results suggest that it is a safe clinical practice to defer CT imaging for patients presenting to the ED with alcohol intoxication and low suspicion for c-spine injury per history and examination.


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        • Torretti JA
        • Sengupta DK.
        Cervical spine trauma.
        Indian J Orthop. 2007; 41: 255-267
        • Goldberg W
        • Mueller C
        • Panacek E
        • Tigges S
        • Hoffman JR
        • Mower WR
        • Group NEXUS
        Distribution and patterns of blunt traumatic cervical spine injury.
        Ann Emerg Med. 2001; 38: 17-21
        • Lowery DW
        • Wald MM
        • Browne BJ
        • Tigges S
        • Hoffman JR
        • Mower WR
        • Group NEXUS
        Epidemiology of cervical spine injury victims.
        Ann Emerg Med. 2001; 38: 12-16
        • Walter J
        • Doris PE
        • Shaffer MA.
        Clinical presentation of patients with acute cervical spine injury.
        Ann Emerg Med. 1984; 13: 512-515
        • 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: 2510-2518
      1. International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM). Centers for Disease Control and Prevention. Accessed December 16, 2022.

        • Como JJ
        • Diaz JJ
        • Dunham CM
        • et al.
        Practice management guidelines for identification of cervical spine injuries following trauma: update from the eastern association for the surgery of trauma practice management guidelines committee.
        J Trauma. 2009; 67: 651-659
        • Kanwar R
        • Delasobera BE
        • Hudson K
        • Frohna W.
        Emergency department evaluation and treatment of cervical spine injuries.
        Emerg Med Clin North Am. 2015; 33: 241-282
        • O'Dowd JK.
        Basic principles of management for cervical spine trauma.
        Eur Spine J. 2010; 19: S18-S22
      2. Weiss AJ, Reid LD, Barrett ML. Overview of Emergency Department Visits Related to Injuries, by Cause of Injury, 2017. HCUP Statistical Brief #266. November 2020. Agency for Healthcare Research and Quality. Accessed December 16, 2022.

        • Martin MJ
        • Bush LD
        • Inaba K
        • et al.
        WTA C-Spine Study Group. Cervical spine evaluation and clearance in the intoxicated patient: A prospective Western Trauma Association Multi-Institutional Trial and Survey.
        J Trauma Acute Care Surg. 2017; 83: 1032-1040
        • Tung M
        • Sharma R
        • Hinson JS
        • Nothelle S
        • Pannikottu J
        • Segal JB.
        Factors associated with imaging overuse in the emergency department: a systematic review.
        Am J Emerg Med. 2018; 36: 301-309
      3. Five Things Physicians and Patients Should Question. Choosing Wisely. Published April 4, 2012. Accessed December 16, 2022.

        • Majeed H
        • Gupta V.
        Adverse Effects of Radiation Therapy.
        StatPearls Publishing, 2022