EBQ:NEXUS cervical trauma rule

incomplete Journal Club Article

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. National Emergency X-Radiography Utilization Study Group.". N Engl J Med. 2001. 343(2):94-9.
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Clinical Question

Can a clinical decision rule be used to evaluate the need for radiography of the cervical spine after blunt trauma?

Conclusion

The NEXUS C-spine rule is a highly sensitive decision rule used to determine the need for radiography in patients with blunt trauma.

Major Points

Five Main Questions:

1. Is a focal neurologic deficit present?
2. Is there midline spinal tenderness?
3. Does the patient have altered mental status?
4. Is the patient intoxicated?
5. Does the patient have an apparent distracting injury?

If the answer is "yes" to any of these questions, imaging in recommended.

Rule had 99% sensitivity and 12.9% specificity for identifying 810 patients with cervical spine injury.

Study Design

• Multicenter, prospective, observational study of ED patients with blunt trauma for whom cervical spine imaging is ordered.
• Completed in 21 centers across the United States (community and university hospitals)
• Each center had a physician who served as liaison to the study (received 1 hour training), and a designated radiologist who ensured correct data collection