For alert (GCS=15, absence of intoxication/sedation) and stable patient where cervical spine injury is a concern (adapted from Stiell et al. 2003).
Computed tomography (CT) is imaging modality of choice in obtunded patients (GCS<15) and in awake and alert patients who do not clear the Canadian C-Spine Rule. Cervical spine radiographs should have an extremely limited role in trauma imaging due to their relative lack of sensitivity for subtle fractures and injuries compared to CT imaging. Plain film x-rays are indicated only in settings where CT is unavailable and neurologic deficit is suspected on physical exam, and only if imaging does not delay definitive care.