{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,17]],"date-time":"2026-01-17T22:46:21Z","timestamp":1768689981180,"version":"3.49.0"},"reference-count":18,"publisher":"BMJ","issue":"10","funder":[{"DOI":"10.13039\/100012319","name":"National Center for Global Health and Medicine","doi-asserted-by":"crossref","id":[{"id":"10.13039\/100012319","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["Emerg Med J"],"accepted":{"date-parts":[[2018,6,21]]},"published-print":{"date-parts":[[2018,10]]},"abstract":"<jats:sec>\n                  <jats:title>Objective<\/jats:title>\n                  <jats:p>Previous cervical spine imaging decision rules have been based on positive findings on plain X-ray and are limited by lack of specificity, age restrictions and complicated algorithms. We previously derived and validated a clinical decision rule (Rule 1) for detecting cervical spine injury (CSI) on CT in a single-centre study. This recommended CT for patients with (1) GCS score &lt;14, (2) GCS 14\u201315 and posterior cervical tenderness or neurological deficit, (3) age \u226560 years and fall down stairs, or (4) age &lt;60\u2009and injured in a motorcycle collision or fallen from height. This study assessed the accuracy and reliability of this rule and refined the rule.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>We conducted a prospective, dual-centre study at two Japanese EDs between August 2012 and March 2014. Patients with head or neck injury \u226516 years of age were included. Clinical data were collected from medical records. Imaging was at the discretion of the treating physician. CSI was diagnosed as a fracture or dislocation seen on CT; patients who were not imaged were followed for 14 days. We analysed the sensitivity and specificity of Rule 1 and refined it post hoc using recursive partitioning.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>1192 patients were enrolled. 927 completed follow-up. Of these, 584 (63.0%) underwent CT imaging and 38 had CSI. Sensitivity and specificity of Rule 1 were 92.1% (95% CI 79.2% to 97.3%) and 58.6% (95% CI 55.4% to 61.9%). A second rule (Rule 2) was derived recommending CT for those with any of the following: GCS &lt;14, cervical tenderness, neurological deficit or mechanism of injury (fall down stairs, motorcycle collision or fall from height) without age limits. Sensitivity and specificity were 100% (95% CI 90.8% to 100%) and 51.9% (95% CI 48.6% to 55.2%), respectively.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>Our initial CT decision rule had lower sensitivity than in our initial validation study. A refined decision rule based on GCS, neck tenderness, neurological deficit and mechanism of injury showed excellent sensitivity with a small loss of specificity. Rule 2 will now need validation in an independent cohort.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1136\/emermed-2017-206930","type":"journal-article","created":{"date-parts":[[2018,7,21]],"date-time":"2018-07-21T12:15:27Z","timestamp":1532175327000},"page":"614-618","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":5,"title":["Development of a new clinical decision rule for cervical CT to detect cervical spine injury in patients with head or neck trauma"],"prefix":"10.1136","volume":"35","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4030-4917","authenticated-orcid":false,"given":"Takeshi","family":"Inagaki","sequence":"first","affiliation":[{"name":"Department of Emergency Medicine and Critical Care, Center Hospital of the National Center for Global Health and Medicine, Tokyo, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Akio","family":"Kimura","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine and Critical Care, Center Hospital of the National Center for Global Health and Medicine, Tokyo, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Go","family":"Makishi","sequence":"additional","affiliation":[{"name":"Department of Emergency and Critical Care Medicine, Seirei Hamamatsu General Hospital, Hamamatsu, Shizuoka, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shigeru","family":"Tanaka","sequence":"additional","affiliation":[{"name":"Department of Emergency and Critical Care Medicine, Seirei Hamamatsu General Hospital, Hamamatsu, Shizuoka, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Noriko","family":"Tanaka","sequence":"additional","affiliation":[{"name":"Biostatistics Section, Department of Clinical Research and Informatics, Clinical Science Center, National Center for Global Health and Medicine, Tokyo, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2018,7,21]]},"reference":[{"key":"2025090222043442000_35.10.614.1","doi-asserted-by":"crossref","first-page":"684","DOI":"10.1097\/00005373-199910000-00012","article-title":"National survey of the incidence of cervical spine injury and approach to cervical spine clearance in U.S. trauma centers","volume":"47","author":"Grossman","year":"1999","journal-title":"J Trauma"},{"key":"2025090222043442000_35.10.614.2","first-page":"285","article-title":"Cervical spine trauma associated with moderate and severe head injury: incidence, risk factors, and injury characteristics","volume":"96","author":"Holly","year":"2002","journal-title":"J Neurosurg"},{"key":"2025090222043442000_35.10.614.3","doi-asserted-by":"publisher","DOI":"10.1097\/TA.0b013e31804798d5"},{"key":"2025090222043442000_35.10.614.4","doi-asserted-by":"crossref","first-page":"94","DOI":"10.1056\/NEJM200007133430203","article-title":"Validity of a set of clinical criteria to rule out injury to the cervical spine in patients with blunt trauma","volume":"343","author":"Hoffman","year":"2000","journal-title":"N Engl J Med Overseas Ed"},{"key":"2025090222043442000_35.10.614.5","doi-asserted-by":"publisher","DOI":"10.1001\/jama.286.15.1841"},{"key":"2025090222043442000_35.10.614.6","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa031375"},{"key":"2025090222043442000_35.10.614.7","doi-asserted-by":"publisher","DOI":"10.1097\/TA.0b013e318220a98c"},{"key":"2025090222043442000_35.10.614.8","doi-asserted-by":"crossref","first-page":"658","DOI":"10.1097\/01.TA.0000088120.99247.4A","article-title":"Are five-view plain films of the cervical spine unreliable? A prospective evaluation in blunt trauma patients with altered mental status","volume":"55","author":"Diaz","year":"2003","journal-title":"J Trauma"},{"key":"2025090222043442000_35.10.614.9","doi-asserted-by":"publisher","DOI":"10.1097\/01.TA.0000162138.36519.2A"},{"key":"2025090222043442000_35.10.614.10","doi-asserted-by":"publisher","DOI":"10.1097\/01.ta.0000239813.78603.15"},{"key":"2025090222043442000_35.10.614.11","doi-asserted-by":"publisher","DOI":"10.1097\/TA.0b013e3181ae583b"},{"key":"2025090222043442000_35.10.614.12","doi-asserted-by":"crossref","first-page":"1098","DOI":"10.1097\/TA.0b013e31827e2acc","article-title":"CT for all or selective approach? Who really needs a cervical spine CT after blunt trauma","volume":"74","author":"Duane","year":"2013","journal-title":"J Trauma Acute Care Surg"},{"key":"2025090222043442000_35.10.614.13","doi-asserted-by":"crossref","first-page":"192","DOI":"10.3893\/jjaam.24.192","article-title":"A clinical decision rule for cervical spine CT in head or neck trauma patients","volume":"24","author":"Inagaki","year":"2013","journal-title":"Nihon Kyukyu Igakukai Zasshi"},{"key":"2025090222043442000_35.10.614.14","doi-asserted-by":"publisher","DOI":"10.1016\/j.annemergmed.2014.01.016"},{"key":"2025090222043442000_35.10.614.15","doi-asserted-by":"publisher","DOI":"10.1038\/sc.1969.30"},{"key":"2025090222043442000_35.10.614.16","doi-asserted-by":"publisher","DOI":"10.1016\/S0196-0644(99)70309-4"},{"key":"2025090222043442000_35.10.614.17","doi-asserted-by":"crossref","first-page":"1095","DOI":"10.1097\/TA.0000000000000650","article-title":"The validity of abdominal examination in blunt trauma patients with distracting injuries","volume":"78","author":"Rostas","year":"2015","journal-title":"J Trauma Acute Care Surg"},{"key":"2025090222043442000_35.10.614.18","doi-asserted-by":"crossref","first-page":"498","DOI":"10.1097\/TA.0b013e3182587634","article-title":"Clinical clearance of the cervical spine in patients with distracting injuries: it is time to dispel the myth","volume":"73","author":"Rose","year":"2012","journal-title":"J Trauma Acute Care Surg"}],"container-title":["Emergency Medicine Journal"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/emermed-2017-206930","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,9,3]],"date-time":"2025-09-03T05:04:43Z","timestamp":1756875883000},"score":1,"resource":{"primary":{"URL":"https:\/\/emj.bmj.com\/lookup\/doi\/10.1136\/emermed-2017-206930"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2018,7,21]]},"references-count":18,"journal-issue":{"issue":"10","published-online":{"date-parts":[[2018,9,24]]},"published-print":{"date-parts":[[2018,10]]}},"alternative-id":["10.1136\/emermed-2017-206930"],"URL":"https:\/\/doi.org\/10.1136\/emermed-2017-206930","relation":{},"ISSN":["1472-0205","1472-0213"],"issn-type":[{"value":"1472-0205","type":"print"},{"value":"1472-0213","type":"electronic"}],"subject":[],"published":{"date-parts":[[2018,7,21]]}}}