Cervical spine clearance: Difference between revisions
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==Decision Rules== | ==Decision Rules== | ||
==NEXUS== | |||
The Nexus Low Risk Criteria | The Nexus Low Risk Criteria | ||
*No posterior midline cervical spine tenderness | *No posterior midline cervical spine tenderness | ||
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*No painful distracting injuries | *No painful distracting injuries | ||
''C-spine imaging indicated unless pt meets all the above'' | ''C-spine imaging indicated unless pt meets all the above''<ref> 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. </ref> <ref>Mahadevan, et al. Interrater reliability of cervical spine injury criteria inpatients with blunt trauma. Ann Emerg Med1998;31:197-201 </ref> | ||
===Canadian C-spine=== | |||
* alert, GCS 15 | * alert, GCS 15 | ||
* not intoxicated | * not intoxicated | ||
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*able to actively rotate neck 45 degrees bilaterally | *able to actively rotate neck 45 degrees bilaterally | ||
''C-spine can be cleared clinically if above criteria met'' | ''C-spine can be cleared clinically if above criteria met''<ref> 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. </ref> <ref> 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. </ref> | ||
==Workup== | ==Workup== | ||
Revision as of 03:07, 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
Decision Rules
NEXUS
The Nexus Low Risk Criteria
- No posterior midline cervical spine tenderness
- No evidence of intoxication
- A normal level of alertness
- No focal neurological deficits
- No painful distracting injuries
C-spine imaging indicated unless pt meets all the above[1] [2]
Canadian C-spine
- alert, GCS 15
- not intoxicated
- no distracting injuries
- not a high risk pt (not > 65, no dangerous mechanism, paresthesias)
- any low risk factor present
- sitting position in ED, ambulatory at any time, delayed neck pain, no midline TTP
- able to actively rotate neck 45 degrees bilaterally
C-spine can be cleared clinically if above criteria met[3] [4]
Workup
Management
Disposition
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.
- ↑ 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.