Canadian C-spine Audit: Appropriateness of C-spine Radiograph Requests in Adult Spinal Injury Assessment ID 10371

Aims and Objectives: To establish whether a newly instituted head and neck care bundle (a checklist document), following recommendations by the initial audit appropriateness of C-spine Radiograph Requests in Spinal Injury or direct CT C-spine in accordance to NICE guidance NG41 showed an improvement in the use of the correct first time modality (X-ray or CT). Methodology: This was a retrospective study using the CRIS system to evaluate all patients that attended accident and emergency in the months of January and February 2019. Thirty-five patients had C-spine radiographs and 127 patients had C-spine CT scans. The patient were categorised into high and low risk based on NICE guidance NG41 and the use of patient notes via Patient First. Results: Data was collected and compared with the first audit (ID1614). 74.4% of patients received the appropriate first line radiological modality, compared with 90.7% of patients after the newly instituted head and neck bundle. Discussion: High risk patients were supposed to have a CT first line while low risk patients were supposed to have plain films as a first line modality. The increase in percentage of patients receiving the correct first line modality was thought to be as a result of the newly instituted head and neck care bundle. Whilst this is an improvement, there were still 15 patients who were at high risk of c-spine fracture who did not receive the appropriate first line modality (CT) and therefore could have been missed.