Quality standard

Quality statement 3: CT cervical spine scans

Quality statement 3: CT cervical spine scans

Quality statement

People attending an emergency department with a head injury have a CT cervical spine scan within 1 hour of a risk factor for spinal injury being identified.

Rationale

Head injuries can be fatal or cause disability if there is damage to the cervical spine that is not identified and treated quickly. A CT cervical spine scan within 1 hour will allow rapid treatment and improve outcomes for people with head injuries that have damaged the cervical spine.

Quality measures

The following measures can be used to assess the quality of care or service provision specified in the statement. They are examples of how the statement can be measured, and can be adapted and used flexibly.

Structure

Evidence of local arrangements to ensure that CT cervical spine scans can be performed within 1 hour of a risk factor for spinal injury being identified in people attending emergency departments with a head injury.

Data source: No routinely collected national data for this measure has been identified. Data can be collected from information recorded locally by healthcare professionals and provider organisations, for example from service protocols.

Process

Proportion of emergency department attendances of people with a head injury for which a CT cervical spine scan is performed within 1 hour of a risk factor for spinal injury being identified.

Numerator – the number in the denominator having a CT cervical spine scan within 1 hour of a risk factor for spinal injury being identified.

Denominator – the number of emergency department attendances of people with a head injury and a risk factor for spinal injury indicating the need for a cervical spine scan.

Data source: Data can be collected from information recorded locally by healthcare professionals and provider organisations, for example from patient records.

What the quality statement means for different audiences

Service providers (emergency departments, hospitals, major trauma centres, trauma units and specialist neurological centres) ensure that a CT cervical spine scan can be performed within 1 hour of a risk factor for spinal injury being identified in people with a head injury.

Healthcare professionals ensure that CT cervical spine scans are performed within 1 hour of a risk factor for spinal injury being identified in people with a head injury.

Commissioners ensure that service providers can perform CT cervical spine scans within 1 hour of a risk factor for spinal injury being identified in people with a head injury. This may be achieved in a number of ways, including the use of 1‑hour targets in acute contracts or enhanced monitoring and audit procedures.

People with a head injury who have any sign showing that the injury might have damaged their neck have a CT scan of their neck within 1 hour of the sign showing.

Source guidance

Head injury: assessment and early management. NICE guideline NG232 (2023), recommendations 1.6.2 to 1.6.4

Definitions of terms used in this quality statement

Risk factors for spinal injury

For people aged 16 and over with a head injury (including people with delayed presentation), any of the following high-risk factors indicates the need for a CT cervical spine scan within 1 hour of the risk factor being identified:

  • the Glasgow Coma Scale (GCS) score is 12 or less on initial assessment

  • the person has been intubated

  • a definitive diagnosis of a cervical spine injury is urgently needed (for example, if cervical spine manipulation is needed during surgery or anaesthesia)

  • there has been blunt polytrauma involving the head and chest, abdomen or pelvis in someone who is alert and stable

  • there is clinical suspicion of a cervical spine injury and any of these factors:

    • age 65 or over

    • a dangerous mechanism of injury (that is, a fall from a height of more than 1 m or 5 stairs, an axial load to the head such as from diving, a high-speed motor vehicle collision, a rollover motor accident, ejection from a motor vehicle, an accident involving motorised recreational vehicles or a bicycle collision)

    • focal peripheral neurological deficit

    • paraesthesia (pins and needles, or a prickling sensation, tingling or itching) in the upper or lower limbs.

[NICE's guideline on head injury, recommendation 1.6.2]

For people aged 16 and over with a head injury, and neck pain or tenderness but no high-risk indications for a CT cervical spine scan, any of the following risk factors indicates the need for a CT cervical spine scan within 1 hour of the risk factor being identified:

  • it is not thought to be safe to assess the range of movement in the neck

  • safe assessment of range of neck movement shows that the person cannot actively rotate their neck 45 degrees to the left and right

  • the person has a condition predisposing them to a higher risk of injury to the cervical spine (for example, axial spondyloarthritis).

[NICE's guideline on head injury, recommendation 1.6.3]

For children and young people aged under 16 with a head injury (including those with a delayed presentation), a CT cervical spine scan should be performed only if any of the following risk factors apply:

  • the GCS score is 12 or less on initial assessment

  • the person has been intubated

  • there are focal peripheral neurological signs

  • there is paraesthesia (pins and needles, or a prickling sensation, tingling or itching) in the upper or lower limbs

  • a definitive diagnosis of cervical spine injury is needed urgently (for example, if manipulation of the cervical spine is needed during surgery or anaesthesia)

  • the person is having other body areas scanned for head injury or multisystem trauma, and there is clinical suspicion of a cervical spine injury

  • there is strong clinical suspicion of injury despite normal X‑rays

  • plain X‑rays are technically difficult or inadequate

  • plain X‑rays identify a significant bony injury.

[NICE's guideline on head injury, recommendation 1.6.4].