Utilization and appropriateness in cervical spine trauma imaging: implementation of clinical decision support criteria

AimsTo rationalize the ordering of trauma cervical spine radiographs via the institution of electronic clinical decision support criteria.MethodsIn February 2017, we added evidence-based criteria to the electronic imaging ordering system so that requesting clinicians had to indicate which criteria the patient met. We subsequently compared numbers of cervical spine trauma films requested by the ED in comparable months prior to and after the intervention.ResultsThe total number of ED trauma cervical spine radiographs reduced by 30.7%, from 182 (in March and April 2016) to 126 (in March and April 2017). The proportion of requests clinically indicated increased from 76.7% (140/182) to 99.2% (125/126). There were no fractures in the 2016 period. 1.6% (2/126) had fractures in the 2017 group.ConclusionIntroduction of clinical indication criteria to the electronic ordering system for cervical spine radiographs in trauma patients reduced the total number of requests by 30.7% while increasing the proportion which were indicated to 99.2%.