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February 6, 2002

Decisions About Cervical Spine Radiography Following Trauma—Reply

Author Affiliations

Stephen J.LurieMD, PhD, Senior EditorIndividualAuthor

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

In Reply: Given the current methodology of clinical decision rule studies,1,2 we believe that Dr Lynch's concerns are minor limitations that offer no threats to the internal or external validity of our study. Our derivation study had neither the intent of validating nor of implementing a decision rule. Seventy-five percent enrollment of eligible patients is quite superb for any clinical study, particularly one in the busy setting of an emergency department. We fully accounted for all patients in our analysis. Patients who could not be followed up and who had no outcome measures were not included in the final analysis. This derivation study generated hypotheses rather than tested them.