NQF C Spine Measure

The following measure has been endorsed by the National Quality Forum.  Harborview Medical Center is the steward of this measure.  For additional information, please contact Dr. Martin Gunn.

 

Measure name:

Percentage of patients undergoing cervical spine radiographs in trauma who do not have neck pain, distracting pain, neurological deficits, reduced level of conciousness or intoxication.

 

Background:

Numerous well designed large prospective studies (specifically the NEXUS and Canadian cervical spine rule studies) have evaluated the efficacy of cervical spine radiography in trauma, and they have found that no patient has had a clinically significant cervical spine injury if they had no neck pain, no distracting pain, no neurological deficits, a normal level of consciousness and no intoxication.

 

This measure addresses the following Institute of Medicine priority areas:

  • Medication management
  • Health information technology
  • Patient safety

 

Measure specifications:

This measure is intended for use in the outpatient setting.

Numerator:  Number of patients who receive cervical spine radiographs for trauma who do not have neck pain, distracting pain, neurological deficits, reduced level of conciousness or intoxication.

Denominator:  Number of cervical spine radiographs performed on trauma patients.

Exclusions

  • Patients who have not experienced trauma.
  • Patients < 16 years of age.
  • Patients with a reduced ability to communicate (permanent verbal or cognitive dysfunction).

Sampling: Do not sample; use all eligible cases.

 

Applicable care settings:

  • Emergency Department/Urgent Care
  • Hospitals of > 200 beds.
  • Oupatient facilities that have radiographic capabilities.
  • Clinician practice/office
  • Acute care hospital.

 

 

Clinical Practice Guideline reference:http://acsearch.acr.org/ProceduresList.aspx?tid=30542&vid=3018823

Specific guideline recommendation: Daffner et al, J Am Coll Radiol. 2007 Nov;4(11):762-75.

 

Controversy/contradictory evidence:  Clinicians feel that over-imaging protects them from legal liability from malpractice.  However, this is not evidence-based.  Radiographic assessment is believed by some to expedite clinical assessment.  However, normal radiographs do not exclude a significant bony, spinal cord or ligamentous injury in symptomatic patients.

 

References

  • Daffner et al, J Am Coll Radiol. 2007 Nov;4(11):762-75.
  • Stiell IG et al, Canadian C-Spine Rule for Radiography in Alert and Stable Trauma Patients JAMA. 2001;286:1841-1848.
  • Yealy DM, et al. Choosing between Clinical Prediction Rules, N Engl J Med. 2003 Dec 25;349(26):2553-5.
  • Blackmore C, Evidence-based imaging evaluation of the cervical spine in trauma, Neuroimaging Clinics of North America , Volume 13 , Issue 2 , Pages 283 – 291.
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