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February 6, 2002

Decisions About Cervical Spine Radiography Following Trauma

Author Affiliations

Stephen J.LurieMD, PhD, Senior EditorIndividualAuthor

JAMA. 2002;287(5):583-584. doi:10.1001/jama.287.5.583

To the Editor: Dr Stiell and colleagues1 attempted to formulate a clinical decision rule (the Canadian C-Spine Rule) for detecting acute cervical spine (C-spine) injury in alert patients following trauma.

I have a number of concerns about their study. First, there was no explanation for the failure to enroll 25.7% (3281) of eligible patients. Second, the authors do not indicate whether or not they attempted to trace the 4.5% (577) of patients who could not be contacted by telephone. It is possible that these patients may have later presented to other hospitals. Similarly, the coroner's office could have been contacted to identify if any patient died as a result of being discharged with a significant C-spine injury. Third, the authors did not consider the possibility of painful distracting injuries, or alcohol or drug intoxication.

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