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

Background: 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 imme-diate immobilization. Current practice as to whether the c-spine can be cleared clinically without radiographic eval-uation 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 guide-lines, stable trauma patients presenting with alcohol intoxi-cation cannot have the c-spine cleared clinically and imaging should be "considered." Objective: This study aimed to as-sess the frequency of computed tomography (CT) c-spine scans ordered for patients presenting with alcohol intoxica-tion to the emergency department (ED), the timing of the studies, and subsequently determine the proportion of which showed a clinically significant result that required interven-tion. Methods: In this retrospective medical record review, all clinically alcohol-intoxicated patients presenting to two academic EDs were included. Overall demographic charac-teristics, time to order of CT imaging, radiology reads, and outcomes of patient visits were determined. Results: 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. Conclusions: This study's results suggest that it is a safe clinical practice to defer CT imaging for patients presenting to the ED with alcohol intox-ication and low suspicion for c-spine injury per history and examination. (c) 2022 Elsevier Inc. All rights reserved.