Application of National Emergency X-Ray Utilizations Study low-risk c-spine criteria in high-risk geriatric falls

Evans, D. A.; Vera, Luis; Jeanmonod, Donald; Pester, J.; Jeanmonod, Rebecca

doi:10.1016/j.ajem.2015.05.031

Cited by 19 publications

(14 citation statements)

References 16 publications

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“…Evans et al reported an injury rate of 7.8%, but their sample was from a high-risk elderly fall population that was triaged to the trauma bay. 13 We think that the incidence of injury in our cohort accurately reflects the experience of most U.S. EDs.…”

Section: Discussionmentioning

confidence: 70%

“…Evans et al 13 demonstrated the validity of the NEXUS criteria in high-risk geriatric falls while maintaining a sensitivity of 100%. A modified NEXUS criteria was used, with more strict definitions of normal alertness and distracting injury.…”

Section: Introductionmentioning

confidence: 99%

“… 14 Evans et al demonstrated an increased specificity with their modified NEXUS criteria compared to the original NEXUS criteria. 13 However, this study was a retrospective review of higher risk elderly falls that were triaged to the trauma bay and probably represent a more injured group than those presenting to the average emergency department (ED).…”

Section: Introductionmentioning

confidence: 99%

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Prospective Validation of Modified NEXUS Cervical Spine Injury Criteria in Low-risk Elderly Fall Patients

Tran¹,

Jeanmonod²,

Agresti³

et al. 2016

WestJEM

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IntroductionThe National Emergency X-radiography Utilization Study (NEXUS) criteria are used extensively in emergency departments to rule out C-spine injuries (CSI) in the general population. Although the NEXUS validation set included 2,943 elderly patients, multiple case reports and the Canadian C-Spine Rules question the validity of applying NEXUS to geriatric populations. The objective of this study was to validate a modified NEXUS criteria in a low-risk elderly fall population with two changes: a modified definition for distracting injury and the definition of normal mentation.MethodsThis is a prospective, observational cohort study of geriatric fall patients who presented to a Level I trauma center and were not triaged to the trauma bay. Providers enrolled non-intoxicated patients at baseline mental status with no lateralizing neurologic deficits. They recorded midline neck tenderness, signs of trauma, and presence of other distracting injury.ResultsWe enrolled 800 patients. One patient fall event was excluded due to duplicate enrollment, and four were lost to follow up, leaving 795 for analysis. Average age was 83.6 (range 65–101). The numbers in parenthesis after the negative predictive value represent confidence interval. There were 11 (1.4%) cervical spine injuries. One hundred seventeen patients had midline tenderness and seven of these had CSI; 366 patients had signs of trauma to the face/neck, and 10 of these patients had CSI. Using signs of trauma to the head/neck as the only distracting injury and baseline mental status as normal alertness, the modified NEXUS criteria was 100% sensitive (CI [67.9–100]) with a negative predictive value of 100 (98.7–100).ConclusionOur study suggests that a modified NEXUS criteria can be safely applied to low-risk elderly falls.

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Section: Discussionmentioning

confidence: 70%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Prospective Validation of Modified NEXUS Cervical Spine Injury Criteria in Low-risk Elderly Fall Patients

Tran¹,

Jeanmonod²,

Agresti³

et al. 2016

WestJEM

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“…31 These criteria have been externally validated in older fall patients. 32 We think the criteria can be applied to older adults but that patients with baseline cognitive impairment should be considered to have an "altered level of consciousness" and thus not meet criteria for avoiding imaging. 33 Rib fractures are also common and morbid in older adults.…”

Section: Traumamentioning

confidence: 99%

Managing the Elderly Emergency Department Patient

Shenvi

Platts‐Mills

2019

Annals of Emergency Medicine

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“…15,16 Recent research has suggested that substituting "deviation from baseline mental status" for "normal level of alertness" and signs of head and neck trauma for distracting injury may improve specificity for detecting clinically significant injuries in geriatric fall patients, though the sample size does not approach the numbers from the original validation cohort. 15,17 Canadian C-Spine Rule…”

Section: Cervical Spine Traumamentioning

confidence: 99%