A 37-year-old man presents to your urgent care center 4 hours after a motor vehicle collision. He reports that he was the unhelmeted rider of a motorcycle traveling 50 mph when he lost control and drove off the road. He refused EMS transport at the scene. He now complains of a headache and neck pain. He reports no loss of consciousness, nausea, or vomiting. He is alert and oriented, and his vital signs are unremarkable and within normal limits. On examination, he has midline cervical spine tenderness but no focal neurologic deficits.
Which of the following is the most appropriate next step in management?
- Discharge home with NSAIDs and strict return precautions
- Call EMS for transport to an emergency department for head and cervical spine CT imaging
- Order cervical spine radiographs in your clinic
- Provide a soft cervical collar and observe in urgent care for 4–6 hours
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Correct Answer: b. Call EMS for transport to an emergency department for head and cervical spine CT imaging.
Applying the Canadian Head CT Rule and the Canadian C-Spine Rule, you determined that the patient met the criteria for CT imaging of both the head and cervical spine. This patient had a high-risk mechanism (unhelmeted motorcycle crash at highway speed) and midline cervical tenderness, which both mandate cervical spine imaging under decision rules such as NEXUS and the Canadian C-spine Rule. He was placed in a supine position on the examination table and maintained C-spine stabilization. A thorough secondary trauma survey was performed. The patient remained immobilized and monitored while EMS was contacted for immediate referral to the ED for definitive imaging and trauma evaluation.
CT is preferred over plain radiographs for high-risk trauma because it is more sensitive for clinically important cervical spine injuries and is the standard in modern trauma evaluation. Because urgent care centers typically cannot provide definitive trauma management (eg, neurosurgical or trauma surgery consultation), he should be transferred to an emergency department for further evaluation and treatment.
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Tracey Davidoff, MD, FACP, FCUCM, has practiced Urgent Care Medicine for more than 15 years. She is Board Certified in Internal Medicine. Dr. Davidoff is a member of the Board of Directors of the Urgent Care Association and serves as Co-Editor-in-Chief of the College of Urgent Care Medicine’s “Urgent Caring” publication. She is also the Vice President of the Southeast Regional Urgent Care Association and a member of the editorial board of the Journal of Urgent Care Medicine. At EB Medicine, Dr Davidoff is Editor-In-Chief of Evidence-Based Urgent Care, and co-host of the Urgentology podcast.
