Original Contributions LOW YIELD OF PAIRED HEAD AND CERVICAL SPINE COMPUTED TOMOGRAPHY IN BLUNT TRAUMA EVALUATION Joseph Graterol, MD,* Maria Beylin, MD,* William D. Whetstone, MD,* Ashleigh Matzoll, BS,* Rennie Burke, MD,* Jason Talbott, MD,† and Robert M. Rodriguez, MD* *Department of Emergency Medicine, University of California, San Francisco, San Francisco, California and †Department of Radiology, University of California, San Francisco, San Francisco, California Corresponding Address: Robert M. Rodriguez, MD, Department of Emergency Medicine, University of California, San Francisco, 1001 Potrero Avenue, San Francisco, CA 94110 , Abstract—Background: With increased computed to- mography (CT) utilization, clinicians may simultaneously order head and neck CT scans, even when injury is sus- pected only in one region. Objective: We sought to deter- mine: 1) the frequency of simultaneous ordering of a head CT scan when a neck CT scan is ordered; 2) the yields of simultaneously ordered head and neck CT scans for clini- cally significant injury (CSI); and 3) whether injury in one region is associated with a higher rate of injury in the other. Methods: This was a retrospective study of all adult patients who received neck CT scans (and simultaneously ordered head CT scans) as part of their blunt trauma evaluation at an urban level 1 trauma center in 2013. An expert panel determined CSI of head and neck injuries. We defined yield as number of patients with injury/number of patients who had a CT scan. Results: Of 3223 patients who met inclusion criteria, 2888 (89.6%) had simultaneously ordered head and neck CT scans. CT yield for CSI in both the head and neck was 0.5% (95% confidence interval [CI] 0.3–0.8%), and the yield for any injury in both the head and neck was 1.4% (95% CI 1.0–1.8%). The yield for CSI in one region was higher when CSI was seen in the other region. Conclusions: The yield of CT for CSI in both the head and neck concom- itantly is very low. When injury is seen in one region, there is higher likelihood of injury in the other. These findings argue against paired ordering of head and neck CT scans and sug- gest that CT scans should be ordered individually or when injury is detected in one region. Ó 2018 Elsevier Inc. All rights reserved. , Keywords—cervical spine CT; head CT; pan-scan; trauma; yields INTRODUCTION Despite the unchanging prevalence of life-threatening injury–related conditions, computed tomography (CT) utilization for adult trauma evaluation has increased dramatically in the past 15 years (1). The driving forces for this escalating CT use include greater avail- ability of rapid CT and a desire to have a near-zero miss rate of injuries during trauma evaluation. Proto- cols that incorporate imaging of multiple anatomic re- gions concurrently are also becoming more prevalent. Whereas head and neck (cervical spine) CT scans used to be ordered separately, it is now common to reflexively order them together, even when injury is suspected in only one or the other. Two of the reasons for this paired ordering may be older literature that indicated high rates of concomitant injury in the head and neck and logistical (patient flow) issues that may occur with the transfer of patients back and forth to CT (2). Reprints are not available from the authors. RECEIVED: 14 November 2017; FINAL SUBMISSION RECEIVED: 1 February 2018; ACCEPTED: 8 February 2018 1 The Journal of Emergency Medicine, Vol. -, No. -, pp. 1–8, 2018 Ó 2018 Elsevier Inc. All rights reserved. 0736-4679/$ - see front matter https://doi.org/10.1016/j.jemermed.2018.02.015