EBQ:NEXUS cervical trauma rule: Difference between revisions
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*Completed in 21 centers across the United States (community and university hospitals) | *Completed in 21 centers across the United States (community and university hospitals) | ||
*Each center had a physician who served as liaison to the study (received 1 hour training), and a designated radiologist who ensured correct data collection | *Each center had a physician who served as liaison to the study (received 1 hour training), and a designated radiologist who ensured correct data collection | ||
*Physicians allowed to order images of patients at their own discretion | |||
**Imaging was an X-ray series of 3 views of C-spine (cross table lateral, AP, open mouth odontoid) unless CT/MRI performed | |||
*All physicians submitted prospective data on all patients before imaging completed, unless patient was clinically unstable | |||
==Population== | ==Population== | ||
Revision as of 18:48, 4 September 2015
Under Review Journal Club Article
Hoffman JR, Mower WR, Wolfson AB, Todd KH, Zucker MI.. "Validity of a Set of Clinical Criteria to Rule Out Injury to the Cervical Spine in Patients with Blunt Trauma. National Emergency X-Radiography Utilization Study Group.". N Engl J Med. 2001. 343(2):94-9.
PubMed Full text PDF
PubMed Full text PDF
Clinical Question
Can a clinical decision rule be used to evaluate the need for radiography of the cervical spine after blunt trauma?
Conclusion
The NEXUS C-spine rule is a highly sensitive decision rule used to determine the need for radiography in patients with blunt trauma.
Major Points
Five Main Questions:
- Is a focal neurologic deficit present?
- Is there midline spinal tenderness?
- Does the patient have altered mental status?
- Is the patient intoxicated?
- Does the patient have an apparent distracting injury?
If the answer is "yes" to any of these questions, imaging in recommended.
Rule had 99% sensitivity and 12.9% specificity for identifying 810 patients with cervical spine injury.
Study Design
- Multicenter, prospective, observational study of ED patients with blunt trauma for whom cervical spine imaging is ordered.[1]
- Completed in 21 centers across the United States (community and university hospitals)
- Each center had a physician who served as liaison to the study (received 1 hour training), and a designated radiologist who ensured correct data collection
- Physicians allowed to order images of patients at their own discretion
- Imaging was an X-ray series of 3 views of C-spine (cross table lateral, AP, open mouth odontoid) unless CT/MRI performed
- All physicians submitted prospective data on all patients before imaging completed, unless patient was clinically unstable
Population
Patient Demographics
Mean age: 37 (range 1-101 years) Gender: 58.7% male
Inclusion Criteria
- Patients with blunt trauma who underwent radiography of the C-spine in participating ED
- Decision wheher to order radiography was made at discretion of the treating physician, according to the criteria he or she ordinarily used
Exclusion Criteria
Interventions
Outcomes
Primary Outcome
Secondary Outcomes
Subgroup analysis
Criticisms & Further Discussion
See Also
External Links
Funding
References
- ↑ Hoffman JR, Wolfson AB, Todd K, Mower WR. Selective cervical spine radiography in blunt trauma: methodology of the National Emergency X-Radiography Utilization Study (NEXUS). Ann Emerg Med. 1998 Oct;32(4):461-9.