Cervical spine clearance: Difference between revisions
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===Specificity=== | ===Specificity=== | ||
Canadian 45.1% vs. Nexus 36.8% | Canadian 45.1% vs. Nexus 36.8% | ||
==Management== | ==Management== |
Revision as of 23:33, 3 September 2015
Background
- US and Canada with more than 13 million trauma pts per year at risk for C-spine injury
- Most blunt trauma patients will be placed in a cervical collar by EMS to protect the C-spine
- C-spine can be clinically cleared by trained personnel
Clinical Features
C-spine injuries may present with
- rarely neurogenic shock (bradycardia, hypotension)
- posterior neck pain
- pain on palpation of spinous processes
- limited neck ROM with pain
- weakness, numbness, or paresthesias
Decision Rules
NEXUS Cervical Spine Rule
Radiography is not necessary if the patient satisfies ALL of the following low risk criteria:
- No midline cervical tenderness
- No focal neuro deficits
- Normal alertness
- No intoxication
- No painful distracting injury
C-spine imaging should be considered unless the patient meets all of the above low risk criteria[1] [2]
Canadian Cervical Spine Rule
No High Risk Factors
- Age >65
- Dangerous mechanism (fall>3ft/5 stairs, high speed MVC (>60mph)/rollover/ejection, bicycle crash, RV, axial load injury)
- Parasthesias in extremities
ANY Low Risk Factor
- Simple rear end MVC
- Delayed onset of pain
- Sitting position in ED
- Ambulatory at any time
- Absence of midline C-spine tenderness
ROM
- Rotates neck 45 degrees to left and right
C-spine can be cleared clinically if above criteria met[3] [4]
Canadian rule vs. Nexus
A single trial showed Canadian rule would pick up 312 or 313 clinically important cases, while NEXUS would miss 1 one in 10 cases[5]
Sensitivity
Canadian 99.4% vs Nexus 90.7%
Specificity
Canadian 45.1% vs. Nexus 36.8%
Management
Disposition
- based on imaging results
See Also
External Links
References
- ↑ 27. Hoffman JR, et al. Low-risk criteria for cervical-spine radiography in blunt trauma: a prospective study. Ann Emerg Med 1992;21:1454-60.
- ↑ Mahadevan, et al. Interrater reliability of cervical spine injury criteria inpatients with blunt trauma. Ann Emerg Med1998;31:197-201
- ↑ Stiell IG,et al. The Canadian C-spine rule for radiography in alert and stable trauma patients. JAMA. 2001 Oct 17;286(15):1841-8. EBQ:Canadian C-spine Rule Study
- ↑ Stiell IG, et al. The Canadian C-spine rule versus the NEXUS low-risk criteria in patients with trauma. N Engl J Med. 2003;349(26):2510-8.
- ↑ Stiell IG, Clement CM, and McKnight DR, et al. The Canadian c-spine rule versus the NEXUS low-risk criteria in patients with trauma. NEJM. 2003; 349:2510-2518.