Concurrent emergency head and cervical spine CT utilization: temporal trends, diagnostic yield, and clinical implications

PURPOSE: To evaluate the diagnostic yield, temporal trends, and clinical implications of concurrent non-contrast head and cervical spine computed tomography (CT) in emergency department trauma patients over a 10-year period. METHODS: This single-center retrospective cohort study included 9,359 consecutive patients who underwent concurrent head and cervical-spine CT for suspected trauma between May 2012 and April 2022. Patient demographics, trauma mechanisms, alcohol documentation, imaging findings, and management of cervical fractures were analyzed. Diagnostic yields were calculated overall and by age, mechanism (with focus on ground-level falls), and time period. Temporal trends and predictors of cervical-spine fracture were assessed using regression models. RESULTS: Acute cervical-spine fractures were present in 4.9% (457/9,359) of patients, while intracranial or craniofacial abnormalities occurred in 23.9% (2,240/9,359). Concurrent abnormalities on both scans were rare (1.3%), with no significant overall association between positive head CT and cervical-spine fracture (OR 1.16, p = 0.174). Imaging volume increased five-fold over the decade, while diagnostic yields declined significantly for both cervical fractures (from 7.1% to 3.9%) and cranial abnormalities (from 28.5% to 22.0%; both p < 0.001). This decline was driven by a rising proportion of ground-level falls (from 47% to 61%), a low-energy mechanism with low yield. Of 457 cervical fractures, 19.9% were treated surgically. CONCLUSIONS: Despite a five-fold increase in concurrent head and cervical spine CT utilization, diagnostic yields declined markedly over the 10-year period, primarily driven by the growing dominance of low-energy ground-level falls. These findings highlight significant overutilization of routine concurrent imaging.