Canadian Cervical Spine Rules: Moving North a Better Option, Eh?

Main Points:

Screen Shot 2015-08-12 at 2.28.35 PM

                                                                      

1. The final Canadian C-spine Rule comprises three questions:

A.) Is there a high-risk factor that mandates radiography such as: age≥65, dangerous mechanism, or paresthesias in extremities?

B.) Is there any low-risk factor that allows safe assessment of range of motion such as: simple rear end MVC, sitting position in ED, ambulatory at any time since injury, delayed onset of neck pain, or absence of midline C-spine tenderness?

C.) Is the patient able to actively rotate neck 45° to the left and right?

 

  1. The Canadian C-Spine Rule was tested on a convenience sample of 8,924 alert and stable trauma patients in 10 Canadian emergency departments with 151 cases of clinically significant C-spine injury and proved to have a sensitivity of 100% (95% CI: 98-100%) and a specificity of 42.5% (95% CI: 40-44%).

 

Background:

Less than three percent of trauma series yield a positive result.

According to the data compiled by the researchers in the Canadian CT Head and C-Spine Study the use of C-spine radiography is quite variable among emergency physician providers based on local culture and the overall cost of C-spine radiography is in the multi-millions. Their research demonstrated that less than three percent of trauma series yield a positive result. Continue reading

NEXUS Review: Clear That Collar Doc!

Screen Shot 2015-08-02 at 11.56.31 AM

This is the first in a blog series that will explore landmark articles in Emergency Medicine. 

Main Points:

  1. Patients meeting the following five simple clinical criteria are safe to clear without cervical spine imaging following blunt trauma:
    • No focal neurologic deficit
    • Normal alertness
    • No intoxication
    • No midline posterior bony cervical spine tenderness, and
    • No painful distracting injury
  1. The sensitivity and specificity of the NEXUS criteria for detecting low probability injury and avoiding unnecessary imaging was 99 and 12.9 percent respectively, with a negative predictive value of 99.8 percent for the detection of clinically significant injuries.

Level of evidence: 1 (Prospective cohort trial)

Based on the ACEP grading scheme for diagnostic questions the NEXUS trial receives a class of evidence rating of 1.

Background:

Blunt trauma is a frequent cause of emergency department visits. However, the overall prevalence of cervical spine injury is generally only between 2-4% (2.4% in the NEXUS cohort). The goal of the NEXUS group was to create a simple clinical tool with which to risk stratify patients following blunt trauma, thereby reducing unnecessary cervical spine imaging and subsequently improving patient care through cost-reduction and a decrement in the downstream oncogenic risk secondary to radiation exposure. Continue reading