Post-traumatic neck pain: a prospective and follow-up study.

Three hundred fifty-one alert emergency department patients with post-traumatic neck pain were evaluated prospectively. Seven (2%) had proven fractures or ligament disruptions. The immediate onset of neck pain and the presence of posterior midline cervical tenderness each had 100% sensitivity, with specificity of 65% and 48%, respectively. Discharged patients were followed up by telephone or letter at a mean of 25 +/- 20 weeks. Of this group, 63% saw another physician, and 43% had persistent moderate-to-severe neck pain or neurologic symptoms at a mean follow-up time of 24 weeks after injury. Of those who had not had a cervical radiograph while in the ED, 52% later obtained one. In addition, 66% of the discharged patients were pursuing litigation. The results suggest that it may be possible to identify alert patients with cervical spine injury by means of history and examination only; however, a larger study confirming these results is required. The high frequency of post-ED radiography, the high prevalence of persistent symptoms after injury, and frequent involvement in litigation are factors to be considered when evaluating ED patients with post-traumatic neck pain. These factors may support the validity of obtaining cervical spine radiographs on many more of these patients than high-yield criteria would dictate.