Nexus C Spine Rules

The Canadian C-spine rule for radiography in alert and stable trauma patients.

Nexus c spine rules. 98-100%) and a specificity of 42.5% (95% CI:. Lateral c-spine, AP and PEG misses 10% of injuries (25-50% of studies being. C-spine plain films are often of better quality in children than adults.

Trauma patients who do not require cervical spine imaging require all of the following:. No painful distracting injury;. N Engl J Med, 03.

Stiell IG, Wells GA,Vandeheem K, et al. Rebbeck, Accuracy of the Canadian C-spine rule and NEXUS to screen for clinically. 5,13 The sensitivity, specificity and negative predictive value of the.

The Canadian C-Spine Rule (CCR) and the National Emergency X-Radiography Utilization Study Low-Risk Criteria (NEXUS criteria) are clinical decision tools developed to help us decide when blunt trauma patients require C-spine X-ray. N Engl J Med. There were 3065 children in the study with only 30 cases of spinal cord injury.

Adopting this rule could decrease imaging in the these patients by 12.6%. NEXUS Cervical Spine Rule. NEXUS criteria for C-spine Clearance.

The Canadian C-Spine (cervical-spine) Rule (CCR) and the National Emergency X-Radiography Utilization Study (NEXUS) Low-Risk Criteria (NLC) are decision rules to guide the use of cervical-spine. No focal neurologic deficit;. In this episode, I discuss the diagnosis of c-spine injuries.

Dynamic fluoroscopy-> until then, collar stays on. Canadian C-spine Rules No patients under 16 Good for adults Not applicable to pediatric patients. The NEXUS Criteria is a clinical decision tool that is used to help medical providers determine the need for a cervical collar after a traumatic event.

Overtesting for cervical spine injury is a widely acknowledged problem. Excluding a cervical spinal injury requires clinical judgement and training. NEXUS rules can be followed to determine whether further imaging is warranted.

Michaleff, Z.A., et al., Accuracy of the Canadian C-spine rule and NEXUS to screen for clinically important cervical spine injury in patients following blunt trauma:. NEXUS (National Emergency X-Radiography Utilization Study) CCR (Canadian C-Spine Rules) Canadian C-spine Rules. Unfortunately, the Canadian C-spine study excluded all patients younger than age 16 and has not been validated in the pediatric population.

A prospective multicenter study of cervical spine injury in children. If we are imaging, it should be with a 3-view reconstructed CT scan. Accuracy of the Canadian C-spine rule and NEXUS to screen for clinically important cervical spine injury in patients following blunt trauma:.

Is there any high-risk factor present that requires cervical spine imaging?. Cochrane Database of Syst. Apply the Canadian C-Spine Rule and NEXUS criteria to aid in the use of clearing C-spines in Adults;.

Stiell IG, Wells GA, Vandemheen KL, Clement CM, Lesiuk H, De Maio VJ, et al. The Canadian C-spine rule versus the NEXUS low-risk criteria in patients with trauma. Additionally, many EMS systems have adopted these criteria for clearing cervical spines in the field prior to transport.

Remember either one of these:. N Engl J Med. Radiography is not necessary if the patient satisfies ALL of the following low risk criteria:.

Clinical decision rules such as the NEXUS criteria and the Canadian C-spine Rule are frequently utilized in adult trauma. Under the NEXUS guidelines, when an acute blunt force injury is present, a cervical spine is deemed to not need radiological imaging if all the following criteria are met:. Evaluate for need of C-spine Xray.

Obtain an MRI of the C-spine. Both studies primarily used plain films in evaluating their patients. A systematic review 12 - Canadian Medical Association Journal.

Accuracy of the Canadian C-spine rule and NEXUS to screen for clinically important cervical spine injury in patients following blunt trauma:. The Canadian C-Spine rule versus the NEXUS low risk criteria in patients with trauma. 3 Michaleff, Z.A., C.G.

New England Journal of Medicine, 03. Stiell IG et al. Often physicians go straight to CT imaging of the c-spine for patients with neck tenderness and moderate/high-risk findings.

The Canadian C-Spine Rule is applicable to patients who are in an alert (Glasgow Coma Scale score of 15) and stable condition following trauma where cervical spine injury is a concern. The Canadian C-spine Rule (CCR). Canadian C-spine rules are a set of guidelines that help a clinician decide if cervical spine imaging is not appropriate for a trauma patient in the emergency department.

In 00, Hoffman et al published the nexus study delineating five criteria to exclude the need for cervical spine (c-spine) radiographs in a "low-risk" emergency department (ED) patient population. Obtain a high-quality CT scan of the C-spine with reformatted images. There are three rules:.

The rule was validated in all age ranges over 1 year, however the small numbers in the study suggest caution may be required in children under 18 years. Studies indicate that NEXUS and CCR are more than 99% accurate at ruling out cervical spine injury, and thus the need for an x-ray. N Engl J Med.

95-99%), though there remains some controversy over. So I find them both to be useful and I'm happy to report to you these are old papers now but Ian Stiell who is the author of the Canadian C-Spine Rules published an article proving his rule was superior to Nexus. The following is based on the NEXUS (National Emergency X-Radiography Utilization Study) criteria.

The NEXUS c-spine rule was validated in children and adults, but just 2.5% were under age 8. Hefferman (05) J Trauma 59(6):. Understand when further imaging with CT and MRI may be indicated;.

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%). NEXUS (National Emergency X-Radiography Utilization Study) is a set of validated criteria used to decide which trauma patients do not require cervical spine imaging. The Canadian C-Spine Rule was tested on a convenience sample of 8,924 alert and stable trauma patients in 10 Canadian emergency departments with 151 cases of clinically significant C-spine injury and proved to have a sensitivity of 100% (95% CI:.

Canadian ER physicians see 0, 000 alert, stable trauma victims per year. Recently, an expert panel came up with an algorithm that’s very helpful for pediatric c-spine clearance. C-spine imaging should be considered unless the patient meets all of the above low risk criteria.

The National Emergency X-Radiography Utilisation Study (NEXUS) 6,10–12 criteria (Table 1) or the Canadian C-spine rule (Figure 1). The Canadian C-Spine (cervical-spine) Rule (CCR) and the National Emergency X-Radi- ography Utilization Study (NEXUS) Low-Risk Criteria (NLC) are decision rules to guide the use of cervical-spine radiography in patients with trauma. Fall from ≥3 ft (0.9 m) / 5 stairs, axial load injury, high speed MVC/rollover/ejection, bicycle collision, motorized recreational vehicle.

The Canadian C-Spine (cervical-spine) Rule (CCR) and the National Emergency X-Radiography 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 study for alert and stable trauma patients. C-spine xrays + CT + an awake patient who can be examined based on ATLS guidelines;.

Accuracy of the Canadian C-spine rule and NEXUS to screen for clinically important cervical spine injury in patients following blunt trauma:. 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. 7 On the other hand, the NEXUS study included 3,065 patients under the age of 18.

An Adult patient with possible cervical spine injury as defined in Section 1 above associated with cervical tenderness should be evaluated as follows:. Canadian C-spine rule and the National Emergency X-Radiography Utilization Study (NEXUS) for detecting clini cally important cervical spine injury following blunt trauma. Two decision rules, the National Emergency X Radiography Utilization Study (NEXUS) Low Risk Criteria (NLC) and the Canadian C-Spine Rule (CCR), both published in 01, were developed to reduce the unnecessary use of C-spine radiography.

Gain an approach to clearing C-Spines in Pediatric Patients;. In adult blunt trauma patients with concern for C-spine injury, the Canadian C-spine Rule (CCR) is an effective clinical tool to screen for those that would require imaging out of concern for clinically significant C-spine injury (sens 100%, NPV 100%). This applies the NEXUS C-Spine Rule to determine whether Xray is recommended.

The 5 NEXUS criteria, if all negative, were 99% sensitive (99.6% sensitive for clinically significant c-spine injury) and had a NPV of 99.8% (99.9% for clinically significant injury). Let’s list down the NEXUS criteria with two versions of the mnemonic. NEXUS Criteria found to have sensitivity of 99.6% for ruling out CSI (2/578).

•Glasgow Coma Scale (GCS) 13-15 with LOC •Amnesia to the head injury event. - Michaleff et al. NEXUS C-Spine Rule Summary:.

The amount of significant injuries missed on x-ray that are picked up on CT is not as substantial as in adults. NEXUS and Canadian C-spine Rules (CCR) Hoffman JR, et al. Recommendation --> Recommendation score=(Q1)+(Q2)+(Q3)+(Q4)+(Q5);score>0?'NEXUS C-Spine Rule recommends obtaining X-ray':'NEXUS C-Spine Rule supports not obtaining X-ray' Canadian CT Head Injury/Trauma Rule Only apply to:.

1396-9 PubMed Konstantinidis (11) J Trauma 71(3):. Lateral c-spine cleared-> take off collar. The Canadian C-spine rule versus the NEXUS low-risk criteria in patients with trauma.

Age ≥65 years, extremity paresthesias, or dangerous mechanism. Ability to detect clinically significant c-spine injury:. Lateral c-spine only misses 15% of injuries;.

- Stiell et al. If both are negative and have been read by the attending radiologist, the C-spine may. Only 905 children age <8 years were enrolled.

Also detected 99.0% (8/818) of ALL c-spine injuries (6 of which were injuries that didn’t require stabilization or specialized treatment). It is unclear how the two decision rules compare in terms of clinical performance. 1 A year later, Stiell et al presented a study from Canada that identified different criteria for excluding c-spine injury (and hence the need for radiography) in a low-risk ED patient population.

In the field, those same. Data on the NEXUS criteria were collected and sensitivity of the rule to exclude a fracture was calculated. Viccellio P, Simon H, Pressman BD, Shah MN, Mower WR, Hoffman JR;.

It is unclear how the two decision rules compare in terms of clinical performance. One of the two widely adopted and evidence based decision rules is used in the initial evaluation of the cervical spine following trauma:. No Cervical Spine imaging needed if all 5 NEXUS Criteria met;.

No focal neuro deficits;. Specificity was low at 12.6%, PPV 2.7%, which has been one of the major complaints about NEXUS. The PECARN group found 8 variables associated with PCSI using a case-control study.

EXtreme distracting injury (painful injury elsewhere that could distract patient from recognizing the pain associated with a neck. Neurologic deficit (focal) 2. The Canadian C-spine rule versus the NEXUS low-risk criteria in patients with trauma.

The NEXUS C-spine decision instrument has been widely adopted and is widely taught to both medical students and residents particularly in Emergency Medicine and trauma surgery. The CCR was developed by Stiell and colleagues in 01. 528-32 PubMed Awake and alert patient with a normal neck and Neurologic Exam and a non-thoracic distracting injury.

No altered level of consciousness;. No midline cervical tenderness;. Over the study period 231,018 patients presented to The Alfred Emergency & Trauma Centre, of whom 14,340 met the institutional trauma registry inclusion criteria and 4035 were aged ≥65years old.

The National X-Radiography Utilization Study Group low-risk rules (NEXUS) and the Canadian C-spine Rule (CCR) are two commonly used clinical decision rules (CDRs) used to reduce the number of cervical spine radiographs obtained in blunt trauma victims 1 2.The creation of these rules was inspired by the fact that clinicians liberally order cervical-spine radiographs in blunt. 2 These differing criteria are presented in the Table. Thoracic Injury is a significant distracting injury and indicates Cervical Spine imaging.

The Nexus may not let you off the hook but the Canadian rules lets you off the hook. A comparison study between the NEXUS Criteria and the Canadian C-Spine Rule suggested that the NEXUS criteria are less sensitive (90.7 vs. I argue that we should not send patients to imaging unless we have used the NEXUS rule and then added the Canadian C-spine Rule to the sequence.

While the Canadian C-Spine Rule is more complex than other c-spine clinical decision rules ( NEXUS ), it is a more sensitive rule and can potentially be used on patients who cannot be cleared using other rules. Cervical Spine Injuries in the ED. NEXUS (00) There is no posterior midline cervical tenderness.

If unable to be cleared by CCSR or NEXUS then imaging is indicated with CT C-spine is indicated CT recommended over xray For significant injury CT has a sensitivity of 100% while xray has a sensitivity 36% 6.