Quality statement 3: CT cervical spine scans

Quality statement

People attending an emergency department with a head injury have a CT cervical spine scan within 1 hour of a risk factor for spinal injury being identified.

Rationale

Head injuries can be fatal or cause disability if there is damage to the cervical spine that is not identified and treated quickly. A CT cervical spine scan within 1 hour will allow rapid treatment and improve outcomes for people with head injuries that have damaged the cervical spine.

Quality measures

Structure

Evidence of local arrangements to ensure that CT cervical spine scans can be performed within 1 hour of a risk factor for spinal injury being identified in people attending emergency departments with head injury.

Data source: Local data collection

Process

a) Proportion of emergency department attendances of people with a head injury for which a CT cervical spine scan is performed within 1 hour of a risk factor for spinal injury being identified.

Numerator – the number in the denominator having a CT cervical spine scan within 1 hour of a risk factor for spinal injury being identified.

Denominator – the number of emergency department attendances of people with a head injury and a risk factor for spinal injury indicating the need for a cervical spine scan.

Data source: Local data collection.

What the quality statement means for service providers, healthcare professionals and commissioners

Service providers (emergency departments, hospitals and specialist neurological centres) ensure that a CT cervical spine scan can be performed within 1 hour of a risk factor for spinal injury being identified in people with a head injury.

Healthcare professionals ensure that CT cervical spine scans are performed within 1 hour of a risk factor for spinal injury being identified in people with a head injury.

Commissioners (clinical commissioning groups and NHS England) ensure that service providers can perform CT cervical spine scans within 1 hour of a risk factor for spinal injury being identified in people with a head injury. This may be achieved in a number of ways including the use of 1‑hour targets in acute contracts or enhanced monitoring and audit procedures.

What the quality statement means for patients, service users and carers

People with a head injury who have any sign showing that the injury might have damaged their neck have a CT scan of their neck within 1 hour of the sign showing.

Source guidance

  • Head injury (NICE clinical guideline 176), recommendations 1.5.8 and 1.5.11 (key priorities for implementation).

Definitions of terms used in this quality statement

Risk factors for spinal injury

For adults with head injury, any 1 of the following risk factors indicates the need for a CT cervical spine scan within 1 hour of the risk factor being identified:

  • Glasgow Coma Scale (GCS) score less than 13 on initial assessment.

  • The patient has been intubated.

  • Plain X‑rays are technically inadequate (for example, the desired view is unavailable).

  • Plain X‑rays are suspicious or definitely abnormal.

  • A definitive diagnosis of cervical spine injury is needed urgently (for example, before surgery).

  • The patient is having other body areas scanned for head injury or multi‑region trauma.

  • The patient is alert and stable, there is clinical suspicion of cervical spine injury and any of the following apply:

    • age 65 years or older

    • dangerous mechanism of injury (fall from a height of greater than 1 metre or 5 stairs; axial load to the head, for example, diving; high‑speed motor vehicle collision; rollover motor accident; ejection from a motor vehicle; accident involving motorised recreational vehicles; bicycle collision)

    • focal peripheral neurological deficit

    • paraesthesia in the upper or lower limbs.

[NICE clinical guideline 176, recommendation 1.5.8].

For children and young people with a head injury, a CT cervical spine scan should be performed only if any of the following apply (because of the increased risk to the thyroid gland from ionising radiation and the generally lower risk of significant spinal injury):

  • GCS score less than 13 on initial assessment.

  • The patient has been intubated.

  • Focal peripheral neurological signs.

  • Paraesthesia in the upper or lower limbs.

  • A definitive diagnosis of cervical spine injury is needed urgently (for example, before surgery).

  • The patient is having other body areas scanned for head injury or multiregion trauma.

  • There is strong clinical suspicion of injury despite normal X‑rays.

  • Plain X‑rays are technically difficult or inadequate.

  • Plain X‑rays identify a significant bony injury.

[NICE clinical guideline 176, recommendation 1.5.11].