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

C. Craig Blackmore, Scott D. Ramsey, Frederick A. Mann, Richard A. Deyo

Research output: Contribution to journalArticlepeer-review

248 Scopus citations


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.

Original languageEnglish (US)
Pages (from-to)117-125
Number of pages9
Issue number1
StatePublished - Jul 1999
Externally publishedYes


  • CT, helical
  • Cost-effectiveness
  • Spine, CT
  • Spine, fractures
  • Trauma

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging


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