NEXUS cervical spine rule: Difference between revisions

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==Work-Up==
==Background==
*Inclusion criteria is [[blunt neck trauma]]
*99.6% sensitive for a clinically important injury (only 12.9% Sp)
*Only 8.6% of patients were elderly in the initial study; use caution in applying to elderly
**Nexus does not risk stratify based on age like CCR
**Small studies show elderly patients with c-spine fractures do not often have midline tenderness


==Workup==
{{C-spine NEXUS}}


Nexus criteria:
Mnemonic - ''NSAID'':
 
#'''N'''euro deficit
1) no midline cervical tenderness
#'''S'''pinal midline tenderness in C-spine
 
#'''A'''lertness
2) no focal neuro deficits
#'''I'''ntoxication
 
#'''D'''istracting injury
3) normal alertness
 
4) no intoxication
 
5) no painful distracting injury
 
 
==Treatment==
 
 
Radiologically identified c spine inj not clinically significant
 
- spinous process fx
 
- simple wedge compression fx < 25%
 
- isolated avvlsion s lig inj
 
- type 1 odontoid fx
 
- end plate fx
 
- inj to trabecular bone
 
- transverse process fx
 
 
==Source==
 
 
6/06 DONALSON (adapted from Mistry)


==See Also==
*[[Blunt neck trauma]]
*[[C-Spine X-Ray]]
*[[Cervical spine clearance]]
*[[Canadian cervical spine rule]]
*[[EBQ:Canadian C-spine Rule Study]]
*[[EBQ:NEXUS]]


==External Links==
*[http://www.mdcalc.com/canadian-c-spine-rule/ MDCalc Canadian C-Spine Rule]
*[http://www.mdcalc.com/nexus-criteria-for-c-spine-imaging/ MDCalc NEXUS]


==References==
<References/>


[[Category:EMS]]
[[Category:Orthopedics]]
[[Category:Radiology]]
[[Category:Trauma]]
[[Category:Trauma]]

Latest revision as of 20:24, 1 January 2017

Background

  • Inclusion criteria is blunt neck trauma
  • 99.6% sensitive for a clinically important injury (only 12.9% Sp)
  • Only 8.6% of patients were elderly in the initial study; use caution in applying to elderly
    • Nexus does not risk stratify based on age like CCR
    • Small studies show elderly patients with c-spine fractures do not often have midline tenderness

Workup

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]

Mnemonic - NSAID:

  1. Neuro deficit
  2. Spinal midline tenderness in C-spine
  3. Alertness
  4. Intoxication
  5. Distracting injury

See Also

External Links

References

  1. 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.
  2. Mahadevan, et al. Interrater reliability of cervical spine injury criteria inpatients with blunt trauma. Ann Emerg Med1998;31:197-201