Clearing the C-Spine in Neurologically Intact Patients: MRI Is Not Cost-Effective if CT Is Negative

The NEXUS cervical spine imaging rule suggests imaging (computed tomography [CT] of the cervical spine) for neurologically intact patients with midline tenderness. However, many providers follow a negative CT scan with magnetic resonance imaging (MRI). Is this approach good for patients? In the absence of clinical trial data, investigators addressed this question with a cost-effectiveness analysis.

The model assumed that a 40-year-old patient was neurologically intact but had midline cervical spine tenderness, and, based on prior literature, that MRI has a false-positive rate of 25% to 40%. The analysis compared a strategy of CT only and a strategy of MRI follow-up if the CT result was negative. The CT-only strategy was superior, with lower …