Introduction to Harborview Criteria
The Harborview high-risk criteria are designed for rapid triage of patients with suspected cervical spine trauma. Their purpose is to avoid missing severe injuries that could lead to disability or death. If at least one criterion is present, X-ray is insufficient — computed tomography (CT) is required.
List of Criteria
An indication for cervical CT is the presence of any of the following factors:
- Severe traumatic brain injury.
- Focal neurological deficit.
- Multiple extremity fractures or pelvic fracture.
- High-energy motor vehicle collision (combined speed >50 km/h or 35 mph).
- Fatality of another vehicle occupant at the scene of the accident.
- Fall from a height of 3 meters or more.
Role of X-ray in Trauma
Although radiography allows for rapid evaluation of large spinal segments, it is not the imaging method of choice in cervical trauma. X-rays can miss up to 55% of clinically significant cervical fractures. Anatomical overlap (e.g., shoulders at the cervicothoracic junction) significantly hinders interpretation. Therefore, in the presence of Harborview risk factors, clinicians proceed directly to more accurate imaging modalities.
To memorize the criteria, you can use the "Neuro-Bones-Kinetics" mnemonic: Neuro (TBI, neurological deficit), Bones (pelvis, multiple fractures), Kinetics (speed >50, height ≥3m, fatality at the scene).
Class and exam questions
Can radiography alone be sufficient in the presence of Harborview criteria?
No. The presence of even a single criterion indicates a high risk, in which case conventional radiography misses more than half of fractures. CT is required.
From what height is a fall considered a high-risk criterion?
Fall from a height of 3 meters or more.
What motor vehicle collision speed is an indication for cervical CT?
Combined impact force at a speed greater than 50 km/h (or 35 mph).
What else to study on this topic
- Red flags in low back pain
- Yellow flags in back pain and psychosocial factors
- Indications for MRI and CT in radiculopathy
- Specifics of cervical, thoracic, and lumbar radiography
- Assessment of spinal stability and functional views
Master the entire topic in the "Diagnostic Radiology" course
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- Complete study guide on "Harborview Criteria" and 2,199 more pages on the subject
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Other topics in the "Spine" section
Prepared by WhiteCoat Pro faculty in accordance with the medical school curriculum. For educational purposes only.