Evaluating referral criteria for local imaging guidelines of the cervical spine in trauma radiography

Abstract

Purpose: A Delphi study was conducted in order to develop a local guideline for cervical spine imaging in trauma cases, for use in the emergency department of a state general hospital in Malta. Objectives: The study compared criteria in established cervical spine imaging guidelines for trauma, with findings in the reviewed literature in order to develop a local guideline. This was reviewed through the use of a Delphi methodology. Methodology: The study utilised self-constructed, anonymous, online Delphi questionnaires to achieve a minimal requirement of an 80% consensus. Nine experts participated in the study, including 3 physicians, 3 radiographers, and 3 radiologists with varying years of experience in the trauma setting. In the first round, a 5-point Likert scale gathered general views. This was later modified to a more focused 3-point Likert scale, in the second round. The participants were also given the option of including their comments for specific questions. Results: In the first round, four criteria reached 100% consensus, and were thus excluded from the second Delphi round. Meanwhile, in the second round, three more criteria achieved 80% consensus. Despite not reaching consensus, the remaining four criteria were still included in the suggested guideline under a separate heading. Conclusion: The Delphi study gave rise to a proposed local guideline for cervical spine trauma cases, incorporating criteria from both NEXUS and CCR guidelines. The suggested guideline is unique to the local clinical scenario, while also taking in consideration the mechanism of trauma of the patients.