Clearance of suspected c-spine injuries in obtunded patient

Clearance of suspected c-spine injuries specifically in AMS is one of the challenging topics in trauma. How do you clear C-spine in obtunded  patient? well, as you know there are 2 methods:  MRI or/and Flex-ex xray.There is a new study published in Annals of Internal Medicine in March:
Cervical Spine Clearance in Obtunded Patients After Blunt Traumatic Injury: A Systematic Review

They Reviewed 28 studies and 7 studies(1686 patients), with low risk of bias and well-interpreted, high-quality CT scans. Primary outcome of interest was clinically significant cervical spine injury missed by CT and detected by the confirmatory test. Their conclusion is:
“Cervical spine clearance in obtunded adults after blunt traumatic injury with negative results from a well-interpreted, high-quality CT scan is probably a safe and efficient practice.”

But we have to appreciate 2 elements if this conclusion:
1. High-quality CT scan (1 to 3 mm)
2. A well-interpreted CT study read by radiologist attending