36.8 percent, P<0.001) for injury, and its use would have resulted in lower radiography rates (55.9 percent vs. Both rules had consistently high sensitivity which indicated that a negative test result was highly informative in excluding a clinically important cervical spine injury and, therefore, the need for radiographic examination. 90.7 percent, P<0.001) and more specific (45.1 percent vs. The Canadian C-spine rule appeared to have better diagnostic accuracy than the NEXUS criteria. In analyses that excluded these indeterminate cases, the CCR was more sensitive than the NLC (99.4 percent vs. In 845 (10.2 percent) of the patients, physicians did not evaluate range of motion as required by the CCR algorithm. The CCR and NLC were interpreted by 394 physicians for patients before ra- diography.Īmong the 8283 patients, 169 (2.0 percent) had clinically important cervical-spine in- juries. This is a clinical decision rule that is highly sensitive for detecting acute C-spine injury and can help emergency department physicians with decisions regarding need for imaging in alert and stable patients. Algorithm: Summary Statement: Stiell et al (2001) have developed a highly. Diagram has been re-designed by the BoringEM. As well, any red flag symptoms, such as paresthesias, a dangerous mechanism, or intoxication, then these rules are not validated. We conducted a prospective cohort study in nine Canadian emergency departments comparing the CCR and NLC as applied to alert patients with trauma who were in stable condition. The Canadian C-spine Rules have excellent sensitivity (90 to 100) 1 but have only been validated for those between the ages of 16-65. It is unclear how the two decision rules compare in terms of clinical performance. TheCanadianC-Spine(cervical-spine)Rule(CCR)andtheNationalEmergencyX-Radi- ography Utilization Study (NEXUS) Low-Risk Criteria (NLC) are decision rules to guide the use of cervical-spine radiography in patients with trauma. The Canadian C-Spine Rule versus the NEXUS Low-Risk Criteria in Patients with Trauma.Guidelines The Canadian C-Spine Rule V the NEXUS Low-Risk Criteria in Patients with Trauma OR (answer yes if no pain) No pain during midline c-spine palpation (answer yes if no pain) 3. Yes Simple rearend MVC OR Ambulatory at any time at scene. National Emergency X-Radiography Utilization Study Group. Factor Which Allows Safe Assessment of Range of Motion No. Hoffman JR, et al.Validity of a set of clinical criteria to rule out injury to the cervical spine in patients with blunt trauma.The Canadian C-spine rule for radiography in alert and stable trauma patients. Only 905 children age <8 years were enrolled of which only four had injuries. There were 3065 children in the study with only 30 cases of spinal cord injury. If the patient is neither high or low risk, then the patient is moderate risk and requires imaging. The NEXUS study enrolled over 34,000 patients (aged less than 1 year to 101) and identified all but 8 of the 818 patients who had cervical spine injury (sensitivity 99.0).If there are no high-risk findings, check to see if the patient qualifies as a low-risk candidate where you might be able to clinically clear the c-spine without imaging.Determine if there are high-risk findings.Make sure that the patient meets the eligibility requirements as in the CCR study.No clinically apparent, painful distracting injury.No posterior midline neck pain or tenderness.StudyĪ patient's neck can be clinically cleared safely without radiographic imaging if all five low-risk conditions are met: Both studies primarily used plain films in evaluating their patients. 25 issue) 1 report the sensitivity of the National Emergency X-Radiography Utilization Study (NEXUS) low-risk criteria (NLC) for. The National Emergency X-radiography Utilization Study (NEXUS) and Canadian C-spine Rules (CCR) are both validated studies which both quote a high sensitivity (over 99%) in detecting clinically significant cervical spine fractures.
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