Cervical spine screening with CT in trauma patients: a cost-effectiveness analysis

Radiology. 1999 Jul;212(1):117-25. doi: 10.1148/radiology.212.1.r99jl08117.


Purpose: To investigate the cost-effectiveness of computed tomography (CT) relative to radiography for cervical spine screening in trauma patients.

Materials and methods: A decision analysis model was constructed to compare the incremental cost-effectiveness of radiography and CT as primary cervical spine screening modalities in trauma patients. Analyses were performed from a societal perspective, and probability and cost estimates from the literature and institutional experience were used. In separate cost-effectiveness analyses, hypothetical cohorts of trauma patients from three defined clinical scenarios were considered: high, moderate, and low risk for cervical spine fracture. Outcome measures included cases of paralysis prevented, total cost of screening strategies, and incremental cost-effectiveness ratios.

Results: In high-risk patients, screening with CT is a dominant strategy that prevents cases of paralysis and saves money for society. In moderate-risk patients, screening with CT is cost-effective with reference-case assumptions and within the range of most sensitivity analyses. In the low-risk group, CT screening helps prevent cases of paralysis, but the incremental cost-effectiveness ratio is high (> $80,000 per quality-adjusted life year).

Conclusion: CT is the preferred cervical spine screening modality in trauma patients at high and moderate risk for cervical spine fracture.

Publication types

  • Research Support, U.S. Gov't, Non-P.H.S.

MeSH terms

  • Adult
  • Aged
  • Cervical Vertebrae / diagnostic imaging
  • Cervical Vertebrae / injuries*
  • Cost-Benefit Analysis
  • Decision Support Techniques
  • Female
  • Head Injuries, Closed / diagnostic imaging
  • Head Injuries, Closed / economics
  • Humans
  • Male
  • Mass Screening / economics*
  • Middle Aged
  • Paralysis / diagnostic imaging
  • Paralysis / economics
  • Quality-Adjusted Life Years
  • Retrospective Studies
  • Risk Factors
  • Sensitivity and Specificity
  • Spinal Fractures / diagnostic imaging
  • Spinal Fractures / economics
  • Spinal Injuries / diagnostic imaging
  • Spinal Injuries / economics*
  • Tomography, X-Ray Computed / economics*