| Title | Retrospective application of the NEXUS low-risk criteria for cervical spine radiography in Canadian emergency departments. | | Author(s) | Dickinson G, Stiell IG, Schull M, Brison R, Clement CM, Vandemheen KL, Cass D, McKnight D, Greenberg G, Worthington JR, Reardon M, Morrison L, Eisenhauer MA, Dreyer J, Wells GA | | Institution | Department of Emergency Medicine, University of Ottawa, Ottawa, Ontario, Canada. | | Source | Ann Emerg Med 2004 Apr; 43(4):507-14. | | MeSH | Adolescent
Adult
Aged
Aged, 80 and over
Canada
Cervical Vertebrae
Emergency Service, Hospital
Female
Humans
Male
Middle Aged
Research Support, Non-U.S. Gov't
Retrospective Studies
Sensitivity and Specificity
Spinal Cord Injuries
Spinal Injuries
Wounds, Nonpenetrating
| | Abstract | STUDY OBJECTIVE: We evaluate the accuracy, reliability, and potential impact of the National Emergency X-Radiography Utilization Study (NEXUS) low-risk criteria for cervical spine radiography, when applied in Canadian emergency departments (EDs).
METHODS: The Canadian C-Spine Rule derivation study was a prospective cohort study conducted in 10 Canadian EDs that recruited alert and stable adult trauma patients. Physicians completed a 20-item data form for each patient and performed interobserver assessments when feasible. The prospective assessments included the 5 individual NEXUS criteria but not an explicit interpretation of the overall need for radiography according to the criteria. Patients underwent plain radiography, flexion-extension views, and computed tomography at the discretion of the treating physician. Patients who did not have radiography were followed up with a structured outcome assessment by telephone to determine clinically important cervical spine injury, a previously validated outcome measurement. Analyses included sensitivity and specificity with 95% confidence interval (CI), kappa coefficient, and potential radiography rates.
RESULTS: Among 8,924 patients, 151 (1.7%) patients had an important cervical spine injury. The combined NEXUS criteria identified important cervical spine injury with a sensitivity of 92.7% (95% CI 87% to 96%) and a specificity of 37.8% (95% CI 37% to 39%). Application of the NEXUS criteria would have potentially reduced cervical spine radiography rates by 6.1% from the actual rate of 68.9% to 62.8%. Of 11 patients with important injuries not identified, 2 were treated with internal fixation and 3 with a halo.
CONCLUSION: This retrospective validation found the NEXUS low-risk criteria to be less sensitive than previously reported. The NEXUS low-risk criteria should be further explicitly and prospectively evaluated for accuracy and reliability before widespread clinical use outside of the United States. | | Language | eng | | Pub Type(s) | Evaluation Studies
Journal Article
| | PubMed ID | 15039695 |
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