Journal of Trauma and Injury

The Korean Society of Traumatology (대한외상학회)
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NEXUS and the Canadian Cervical Spine Rule as a Screening Tool for Computed Tomography Evaluation in Patients with Cervical Spine Injury

경추 손상 환자에서 전산화 단층 촬영 시행을 위한 임상적 기준 : NEXUS 기준과 Canadian cervical spine rule

  • Choi, Yang Hwan (Department of Emergency Medicine, Yonsei University College of Medicine) ;
  • Cho, Junho (Department of Emergency Medicine, Yonsei University College of Medicine) ;
  • Choa, Minhong (Department of Emergency Medicine, Yonsei University College of Medicine) ;
  • Park, Yoo Seok (Department of Emergency Medicine, Yonsei University College of Medicine) ;
  • Chung, Hyun Soo (Department of Emergency Medicine, Yonsei University College of Medicine) ;
  • Chung, Sung Pil (Department of Emergency Medicine, Yonsei University College of Medicine)
  • 최양환 (연세대학교 의과대학 응급의학교실) ;
  • 조준호 (연세대학교 의과대학 응급의학교실) ;
  • 좌민홍 (연세대학교 의과대학 응급의학교실) ;
  • 박유석 (연세대학교 의과대학 응급의학교실) ;
  • 정현수 (연세대학교 의과대학 응급의학교실) ;
  • 정성필 (연세대학교 의과대학 응급의학교실)
  • Received : 2008.05.16
  • Accepted : 2008.06.10
  • Published : 2008.06.30
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Abstract

Purpose: National Emergency X-Radiography Utilization Study (NEXUS) criteria and the Canadian Cervical Spine rule (CCR) are commonly used in cervical trauma patients to determine whether a plain cervical X-ray should be performed. However, plain cervical X-rays are so inaccurate that cervical spine computed tomography (CT) is often considered as a screening test. We studied the usefulness of the NEXUS criteria and the CCR for determining the need for a CT evaluation in the emergency department (ED). Methods: This prospective observational study was conducted from January 2007 to March 2008. Plain X-ray and CT scans of the cervical spine were performed on blunt trauma patients with neck pain. The relevancy of CT was examined using the NEXUS criteria and the CCR. Sensitivity, specificity, positive predicted value, and negative predicted value analyses were performed to diagnose the cervical spine injury. Results: During the study period, 284 patients were enrolled in this study. The sensitivity, specificity, positive predicted value, and negative predicted value of the NEXUS criteria were 87.5%, 1.1%, 5.0%, and 60.0% respectively, while those of the CCR were 87.5%, 8.2%, 5.3%, and 91.6%. There were two missed fracture cases when the NEXUS criteria and the CCR were applied independently, however, no cases were missed when both were applied. Conclusion: This study suggests the NEXUS and the CCR in combination can be used as a guide to CT evaluation for cervical spine injury in the ED.

Keywords

References

  1. Grossman MD, Reilly PM, Gillett T, Gillett D. National survey of the incidence of cervical spine injury and approach to cervical spine clearance in U.S. trauma centers. J Trauma 1999;47:684-91 https://doi.org/10.1097/00005373-199910000-00012
  2. Davis JW, Phreaner DL, Hoyt DB, Mackersie RC. The etiology of missed cervical spine injuries. J Trauma 1993;34:342-6
  3. Sanchez B, Waxman K, Jones T, Conner S, Chung R, Becerra S. Cervical Spine Clearance in Blunt Trauma: Evaluation of a Computed Tomography-Based Protocol. J Trauma 2005;59:179-83 https://doi.org/10.1097/01.TA.0000171449.94650.81
  4. Sokolowski MJ, Jackson AP, Haak MH, Meyer PR Jr, Sokolowski MS. Acute mortality and complications of cervical spine injuries in the elderly at a single tertiary care center. J Spinal Disord Tech 2007;20:352-6 https://doi.org/10.1097/BSD.0b013e31802d0bc5
  5. Hoffman JR, Wolfson AB, Todd K, Mower WR. Selective Cervical Spine Radiography in Blunt Trauma: Methodology of the National Emergency XRadiography Utilization Study (NEXUS). Ann Emerg Med 1998;32:461-9 https://doi.org/10.1016/S0196-0644(98)70176-3
  6. Stiell IG, Wells GA, Vandemheen KL, Clement CM, Lesiuk H, De Maio VJ, et al. The Canadian C-spine rule for radiography in alert and stable trauma patients. JAMA 2001;286:1841-8 https://doi.org/10.1001/jama.286.15.1841
  7. Besman A, Kaban J, Jacobs L, Jacobs LM. False-negative plain cervical spine x-rays in blunt trauma. Am Surg 2003;69:1010-4
  8. Crim J, Moore K, Brodke D. Clearance of the cervical spine in multi-trauma patients: the role of advance imaging. Semin Ultrasound CT MR 2001;22:283-305 https://doi.org/10.1016/S0887-2171(01)90023-X
  9. Hanson JA, Deliganis AV, Baxter AB, Cohen WA, Linnau KF, Wilson AJ, et al. Radiologic and clinical spectrum of occipital condyle fractures: retrospective review of 107 consecutive fractures in 95 patients. Am J Roentgenol 2002;178:1261-8 https://doi.org/10.2214/ajr.178.5.1781261
  10. Stiell IG, Clement CM, Mcknight RD, Brison R, Schull MJ, Rowe BH, et al. The Canadian C-Spine Rule versus the NEXUS Low-Risk Criteria in Patients with Trauma. N Engl J Med 2003;349:2510-8 https://doi.org/10.1056/NEJMoa031375
  11. Daffner RH. Cervical Radiography for Trauma Patients: A Time-Effective Technique? Am J Roentgenol 2000;175:1309-11 https://doi.org/10.2214/ajr.175.5.1751309
  12. Fisher A, Young WF. Is the lateral cervical spine xray obsolete during the initial evaluation of patients with acute trauma? Surg Neurol 2008 In press
  13. Hoffman JR, Schriger DL, Mower W, Luo JS, Zucker M. Low-risk criteria for cervical-spine radiography in blunt trauma: a prospective study. Ann Emerg Med 1992;21:1454-60 https://doi.org/10.1016/S0196-0644(05)80059-9
  14. 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. N Engl J Med 2000;343:94-9 https://doi.org/10.1056/NEJM200007133430203
  15. Gale SC, Gracias VH, Reilly PM, Schwab CW. The Inefficiency of Plain Radiography to Evaluate the Cervical Spine After Blunt Trauma. J Trauma 2005;59:1121-5
  16. Reid DC, Henderson R, Saboe L, Miller JD. Etiology and clinical course of missed spine fractures. J Trauma 1987;27:980-6 https://doi.org/10.1097/00005373-198709000-00005
  17. Griffen MM, Frykberg ER, Kerwin AJ, Schinco MA, Tepas JJ, Rowe K, et al. Radiographic Clearance of Blunt Cervical Spine Injury: Plain Radiograph or Computed Tomography Scan? J Trauma 2003;55:222-7 https://doi.org/10.1097/01.TA.0000083332.93868.E2
  18. Hanson JA, Blackmore CC, Mann FA, Wilson AJ. Cervical Spine Injury: A Clinical Decision Rule to Identify High-Risk Patients for Helical CT Screening. Am J Roentgenol 2000;174:713-7 https://doi.org/10.2214/ajr.174.3.1740713
  19. Grogan EL, Morris JA Jr, Dittus RS, Moore DE, Poulose BK, Diaz JJ, et al. Cervical Spine Evaluation in Urban Trauma Centers: Lowering Institutional Costs and Complications Through Helical CT Scan. J Am Coll Surg 2005;200:160-5 https://doi.org/10.1016/j.jamcollsurg.2004.10.019
  20. Park HJ, Kim IG, Lee DH, Yang SH. Magnetic Resonance Imaging of Acute Cervical Cord Injuries (Clinical Correlation and Prognosis). J Korean Soc Spine Surg 2001;8:156-64 https://doi.org/10.4184/jkss.2001.8.2.156
  21. Como JJ, Thompson MA, Anderson JS, Shah RR, Claridge JA, Yowler CJ, et al. Is magnetic resonance imaging essential in clearing the cervical spine in obtunded patients with blunt trauma? J Trauma 2007;63:544-9 https://doi.org/10.1097/TA.0b013e31812e51ae