EBQ:NEXUS cervical trauma rule - Revision history

ClaireLewis: /* Patient Demographics */

2016-07-14T02:18:38Z

Patient Demographics

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	===Patient Demographics===		===Patient Demographics===
	Mean age: 37 (range 1-101 years)		Mean age: 37 (range 1-101 years)
	~~Gender~~: 58.7% male		Sex: 58.7% male

	===Inclusion Criteria===		===Inclusion Criteria===

Rossdonaldson1: Rossdonaldson1 moved page EBQ:NEXUS to EBQ:NEXUS cervical trauma rule

2016-05-11T12:40:53Z

Rossdonaldson1 moved page EBQ:NEXUS to EBQ:NEXUS cervical trauma rule

← Revisión anterior	Revisión del 12:40 11 may 2016
(Sin diferencias)

Ostermayer at 15:21, 7 September 2015

2015-09-07T15:21:58Z

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	\| fulltexturl=http://www.nejm.org/doi/full/10.1056/NEJM200007133430203#t=article		\| fulltexturl=http://www.nejm.org/doi/full/10.1056/NEJM200007133430203#t=article
	\| pdfurl=http://www.nejm.org/doi/pdf/10.1056/NEJM200007133430203		\| pdfurl=http://www.nejm.org/doi/pdf/10.1056/NEJM200007133430203
	\| status=~~Under Review~~		\| status=Complete
	}}		}}

Ostermayer: /* See Also */

2015-09-07T15:21:40Z

Ostermayer: /* Major Points */

2015-09-05T23:14:54Z

Major Points

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	==Major Points==		==Major Points==
	Five Main Questions:		'''Five Main Questions:'''
	{{NEXUS Criteria}}		{{NEXUS Criteria}}

Ostermayer: /* Major Points */

2015-09-05T23:14:38Z

Major Points

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	{{NEXUS Criteria}}		{{NEXUS Criteria}}

	If the answer is "yes" to any of these questions, imaging in recommended.		*If the answer is "yes" to any of these questions, imaging in recommended.
			*The rule had 99% sensitivity and 12.9% specificity for identifying 810 patients with cervical spine injury.
	~~Rule~~ had 99% sensitivity and 12.9% specificity for identifying 810 patients with cervical spine injury.		*The [[EBQ:Canadian_C-spine_Rule\|Canadian C-spine Rule]] is also useful for risk stratifying patients into low risk groups that can foregoe cervical spine radiographs. While the NEXUS criteria uses 5 items, the [[Canadian_cervical_spine_rule\|Canadian cervical spine rule]] uses 3 high risk, 5 low risk and pain free rotation of the neck to stratify trauma patients.

	==Study Design==		==Study Design==

Ostermayer: /* Conclusion */

2015-09-05T23:10:34Z

Conclusion

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	==Conclusion==		==Conclusion==
	The NEXUS C-spine rule is a highly sensitive decision rule used to ~~determine~~ the ~~need for~~ radiography in patients with blunt trauma.		The NEXUS C-spine rule is a highly sensitive decision rule used to guide the use of cervical-spine radiography in patients with blunt trauma.

	==Major Points==		==Major Points==

Ostermayer: /* Criticisms & Further Discussion */

2015-09-05T23:09:33Z

Criticisms & Further Discussion

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	*At the time some considered a five views c-spine series to be the standard and thus a false sense of security could be found using less views as was done in this study (cross-table lateral, anteroposterior, open-mouth, and right and left obliques)		*At the time some considered a five views c-spine series to be the standard and thus a false sense of security could be found using less views as was done in this study (cross-table lateral, anteroposterior, open-mouth, and right and left obliques)
	*Prospective evaluation of NEXUS in the setting of CT scanning rather than plain films did identify a 0.9% miss rate<ref>Duane TM. et al. National Emergency X-Radiography Utilization Study criteria is inadequate to rule out fracture after significant blunt trauma compared with computed tomography. J Trauma. 2011 Apr;70(4):829-31 </ref>		*Prospective evaluation of NEXUS in the setting of CT scanning rather than plain films did identify a 0.9% miss rate<ref>Duane TM. et al. National Emergency X-Radiography Utilization Study criteria is inadequate to rule out fracture after significant blunt trauma compared with computed tomography. J Trauma. 2011 Apr;70(4):829-31 </ref>
	*The [[Canadian cervical spine rule]] has been shown to be more sensitive than [[NEXUS]] (99.4 percent vs. 90.7 percent, P<0.001) and more specific (45.1 percent vs. 36.8 percent, P<0.001) for injury, and its may result in lower radiography rates<ref>Stiell, Ian et al. The Canadian C-Spine Rule versus the NEXUS Low-Risk Criteria in Patients with Trauma. N Engl J Med 2003; 349:2510-2518</ref>		*The [[Canadian cervical spine rule]] in a single study has been shown to be more sensitive than [[NEXUS]] (99.4 percent vs. 90.7 percent, P<0.001) and more specific (45.1 percent vs. 36.8 percent, P<0.001) for injury, and its may result in lower radiography rates<ref>Stiell, Ian et al. The Canadian C-Spine Rule versus the NEXUS Low-Risk Criteria in Patients with Trauma. N Engl J Med 2003; 349:2510-2518</ref>

	==See Also==		==See Also==

Ostermayer: /* Criticisms & Further Discussion */

2015-09-05T23:06:30Z

Criticisms & Further Discussion

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	**May reflect an influence of the previous study on participating institutions		**May reflect an influence of the previous study on participating institutions
	*At the time some considered a five views c-spine series to be the standard and thus a false sense of security could be found using less views as was done in this study (cross-table lateral, anteroposterior, open-mouth, and right and left obliques)		*At the time some considered a five views c-spine series to be the standard and thus a false sense of security could be found using less views as was done in this study (cross-table lateral, anteroposterior, open-mouth, and right and left obliques)
			*Prospective evaluation of NEXUS in the setting of CT scanning rather than plain films did identify a 0.9% miss rate<ref>Duane TM. et al. National Emergency X-Radiography Utilization Study criteria is inadequate to rule out fracture after significant blunt trauma compared with computed tomography. J Trauma. 2011 Apr;70(4):829-31 </ref>
			*The [[Canadian cervical spine rule]] has been shown to be more sensitive than [[NEXUS]] (99.4 percent vs. 90.7 percent, P<0.001) and more specific (45.1 percent vs. 36.8 percent, P<0.001) for injury, and its may result in lower radiography rates<ref>Stiell, Ian et al. The Canadian C-Spine Rule versus the NEXUS Low-Risk Criteria in Patients with Trauma. N Engl J Med 2003; 349:2510-2518</ref>

	==See Also==		==See Also==

Ostermayer: /* Interventions */

2015-09-05T22:53:39Z

Interventions

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	*Those who underwent cervical-spine imaging for any other reason, unrelated to trauma		*Those who underwent cervical-spine imaging for any other reason, unrelated to trauma

	==Interventions==		==Interventions==
			The NEXUS study was an observational trial

	==Outcomes==		==Outcomes==
	n=34,069 patient evaluated y imaging of cervical spine		n=34,069 patient evaluated y imaging of cervical spine

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	==See Also==		==See Also==
	*[[NEXUS cervical spine rule]]		*[[NEXUS cervical spine rule]]
			*[[Cervical spine fractures and dislocations]]

	==External Links==		==External Links==
	*[http://www.mdcalc.com/nexus-criteria-for-c-spine-imaging/ MDCalc]		*[http://www.mdcalc.com/nexus-criteria-for-c-spine-imaging/ MDCalc]