Dr Kola Tytler MBBS CertHE MBA MRCGPClinical Lead • iatroX
Consider referring a patient with neck trauma to a specialist for further evaluation or management if:
- There is clinical suspicion of a cervical spine injury with any high-risk factors such as age 65 or over, dangerous mechanism of injury (e.g., fall from height, high-speed motor vehicle collision), focal peripheral neurological deficit, or paraesthesia in limbs. In these cases, urgent CT cervical spine imaging and specialist input are indicated NICE NG232.
- The patient has a Glasgow Coma Scale (GCS) score of 12 or less, has been intubated, or blunt polytrauma involving head and other body regions is present, requiring urgent specialist assessment NICE NG232.
- Neurological abnormalities attributable to spinal cord injury are present, warranting MRI after CT and immediate specialist referral NICE NG41.
- In trauma units, if a spinal cord injury is identified, the trauma team leader should immediately contact the specialist neurosurgical or spinal surgeon on call NICE NG41.
- For children under 16 with suspected cervical spine injury or spinal cord injury, specialist referral and MRI are recommended NICE NG41.
- If imaging (X-ray or CT) confirms spinal column fracture or injury, further specialist evaluation is necessary NICE NG41.
- When full in-line spinal immobilisation is required due to high-risk factors or inability to safely assess the neck, specialist involvement is indicated NICE NG232,NICE NG41.
In summary, referral to a specialist is warranted when there is high clinical suspicion of cervical spine injury, neurological deficits, confirmed fractures, or when advanced imaging and management are needed beyond initial assessment NICE NG232,NICE NG41.