Accuracy of the Canadian C-spine rule and NEXUS to screen for clinically important cervical spine injury in patients following blunt trauma: a systematic review

Michaleff, Zoe A; Maher, Christopher G.; Verhagen, Arianne P.; Rebbeck, Trudy; Lin, Chung‐Wei Christine

doi:10.1503/cmaj.120675

Cited by 124 publications

(74 citation statements)

References 29 publications

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“…11,24,25 In cases of suspected cervical vascular injury, either CT or magnetic resonance angiography may be used to evaluate the extent of vessel injury and perfusion by contrast distribution. 50,64 It is noteworthy that overt structural or hard neurological clinical findings are rare in the vast majority of patients in the emergent care setting, 80,100 which seems to fit with the accepted position that most recovery should occur within the first 3 months following an MVC. 15 However, for some patients, recovery is not spontaneous or unremarkable.…”

Section: Imaging Clinical Decision Rules Cmentioning

confidence: 89%

Advancements in Imaging Technology: Do They (or Will They) Equate to Advancements in Our Knowledge of Recovery in Whiplash?

Elliott¹,

Dayanidhi

Hazle

et al. 2016

J Orthop Sports Phys Ther

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Section: Imaging Clinical Decision Rules Cmentioning

confidence: 89%

Advancements in Imaging Technology: Do They (or Will They) Equate to Advancements in Our Knowledge of Recovery in Whiplash?

Elliott¹,

Dayanidhi

Hazle

et al. 2016

J Orthop Sports Phys Ther

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“…Currently there are two clinical decision rules, the Canadian C-Spine Rule (CCR) (Appendix A) and the National Emergency X-Radiography Utilization Study (NEXUS) (Appendix B) available to assess the need for imaging in patients with cervical spine injury (Michaleff, Maher, Verhagen, Rebbeck, & Lin, 2012).…”

Section: Decision Making Toolsmentioning

confidence: 99%

“…According NEXUS criteria, cervical spine radiography is indicated for patients with neck trauma unless they meet all of the following criteria, no posterior midline cervical-spine tenderness, no evidence of intoxication, a normal level of alertness (GCS=15), no focal neurologic deficit, and no painful distracting injuries (Michaleff et al, 2012).…”

Section: Decision Making Toolsmentioning

confidence: 99%

“…The accuracy of the Canadian C-Spine rule was compared to the NEXUS criteria in a systematic review by Michaleff et al, (2012). The purpose of this systematic review was to describe the quality of research evaluating the CCR and NEXUS.…”

Section: Evaluating the Ccr And Nexus Criteriamentioning

confidence: 99%

“…NEXUS low-risk criteria utilized to decrease the number of unnecessary radiographs and decrease patient immobilization times (Michaleff, Maher, Verhagen, Rebbeck, Lin, (2012).…”

Section: Recommendations and Implications For Advanced Nursing Practicementioning

confidence: 99%

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Comparing the Canadian Cervical Spine Rule and Radiology Confirmed Cervical Spine Injury in the Emergency Department

Arnold¹

2017

Preprint

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In the United States and Canada, more than 13 million trauma patients are at risk for cervical spine injury (CSI). To date, providers use computerized tomography (CT) to rule out CSI in these patients. Cervical spine immobilization with the use of rigid cervical collars can be uncomfortable, delays hospital transport, and has a modest morbidity. The Canadian Cervical Spine Rule (CCR) is a screening tool used in emergency departments (ED) as a screening tool to rule out CSI to avoid unnecessary CTs. The purpose of this project is to complete a retrospective chart review to evaluate if emergency departments can apply the CCR to reduce cervical spine radiographs in the adult patient with suspected CSI. The study was a retrospective chart review, which took place at a level 2 trauma center emergency department in a community teaching hospital reviewing patient records and radiological findings in relation to the potential benefit of using the CCR in CSI assessment. The sample was a non-probability convenience sample of patients who have had a cervical spine radiograph in the ED. One hundred charts were reviewed and 60 patient records were included in the study. Of the 60 records included in the study, half met high risk criteria requiring cervical spine radiography. Of the 30 records meeting low risk criteria, only 2 charts had complete documentation including neck range of motion (ROM). One had normal ROM and one was unable to actively rotate neck.There were 8 records that documented "normal range of motion" but did not specifically note normal neck ROM. It is difficult to definitively state that 28 CTs could have been prevented, as there was inadequate neck range of motion documentation. There were no cervical spine injuries detected by CT in this study. As with previous studies, the data shows that the CCR maintains its sensitivity but has low specificity. It remains that clinicians still rely on radiology evidence to rule out CSI rather than assessment tools.

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Canadian C-spine rule and the National Emergency X-Radiography Utilization Study (NEXUS) for detecting clinically important cervical spine injury following blunt trauma

Saragiotto

Maher

Lin

et al. 2018

Cochrane Database of Systematic Reviews

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A B S T R A C TThis is a protocol for a Cochrane Review (Diagnostic test accuracy). The objectives are as follows:To describe and compare the diagnostic accuracy of the Canadian C-spine rule and the National Emergency X-Radiography Utilization Study (NEXUS) to screen for clinically important cervical spine injury (CSI) in patients following blunt trauma. 1 Canadian C-spine rule and the National Emergency X-Radiography Utilization Study (NEXUS) for detecting clinically important cervical spine injury following blunt trauma (Protocol)

show abstract

Accuracy of the Canadian C-spine rule and NEXUS to screen for clinically important cervical spine injury in patients following blunt trauma: a systematic review

Cited by 124 publications

References 29 publications

Advancements in Imaging Technology: Do They (or Will They) Equate to Advancements in Our Knowledge of Recovery in Whiplash?

Advancements in Imaging Technology: Do They (or Will They) Equate to Advancements in Our Knowledge of Recovery in Whiplash?

Comparing the Canadian Cervical Spine Rule and Radiology Confirmed Cervical Spine Injury in the Emergency Department

Canadian C-spine rule and the National Emergency X-Radiography Utilization Study (NEXUS) for detecting clinically important cervical spine injury following blunt trauma

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