Application of the Canadian C-Spine rule and nexus low criteria and results of cervical spine radiography in emergency condition

Abstract

IntroductionThe Canadian C Spine Rule (CCR) and the National Emergency X-Radiography Utilization Study (Nexus) low criteria are well accepted as guide to help physician in case of cervical blunt trauma.MethodsWe aimed to evaluate retrospectively the application of these recommendations in our emergency department. Secondly we analyzed the quality of cervical spine radiography (CSR) in an emergency setting.Results281 patients with cervical blunt trauma were analyzed retrospectively. The CCR and the NEXUS rules were respected in 91.2% and 96.8% of cases respectively. No lesions were found in 96.4% of patient. A lesion was present in 1.1% of patient and suspected in 2.5% of patient. The quality of CSR was adequate in only 37.7% of patient. The poor quality of CSR was due either to the lack of C7 vertebrae visualization in 64.6% or other lower vertebrae in 28%. Other causes included the absence of open mouth view (8%), the absence C1 vertebrae visualization (3.4%), artifact in 2.3% and the absence of lateral view in 0.6% of patient.ConclusionCCR and NEXUS are widely used in our emergency department. The high rate of inadequate CSR reinforces the debate about it’s utility in emergency condition.

Fracture heat map of the facial skull demonstrates a danger zone of concomitant cervical spine injuries

“…Still, CSI is often misdiagnosed even though the awareness of a thoroughly examination of the patients should be in routine practice of every trauma center 18 , 20 – 23 . Since severe cervical spine injuries can also be asymptomatic, it is important to perform an emergency radiologic assessment, for this purpose according to the ATLS guidelines 9 , 18 , 20 , 21 , 23 – 25 . A proper initial assessment of the patient at the accident site and in the emergency room allows the initiation of adequate therapy, and if required, surgical therapy for both MFI and CSI to decrease overall complications 5 , 21 , 25 .…”

Algorithms for Clinical Assessment of the Cervical Spine in Patients With Severe Trauma: A Mixed-Method Analyzis

“…The most reliable method from the residents' point of view was the CCR (9.15% vs. 7.77%). Seeking to infer something from this variable, a study checked how many times the CCR and NEXUS protocol indications for each examination were respected by those who applied it, estimating a reliability of 91.2% and 96.8%, respectively, 24 showing the opposite of the data found here, possibly due to the measurement technique used. Two other Canadian studies that evaluated only the CCR protocol when used by nurses found reported reliability of 95.2% and 98.7% in two different years.…”

Fracture Heat Map of The Facial Skull Demonstrates a Danger Zone of Concomitant Cervical Spine Injuries

“…The initial assessment of patients in the emergency room is essential to detect life-threatening injuries or injuries that can lead to permanent disabilities [20][21][22]25 . Most maxillofacial injuries can easily be diagnosed, as the symptoms are relatively easy to assess.…”

“…Since severe cervical spine injuries can also be asymptomatic, it is important to perform an emergency radiologic assessment, for this purpose according to the ATLS guidelines 9,18,20,21,23−25 . A proper initial assessment of the patient at the accident site and in the emergency room allows the initiation of adequate therapy, and if required, surgical therapy for both MFI and CSI to decrease overall complications 5,21,25 .…”