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

Saragiotto, Bruno Tirotti; Maher, Christopher G.; Lin, Chung‐Wei Christine; Verhagen, Arianne P.; Goergen, Stacy; Michaleff, Zoe A

doi:10.1002/14651858.cd012989

Cited by 13 publications

(8 citation statements)

References 22 publications

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“…Higher grade injury to the spine is associated with a severe neurological picture including genito-phincter disorders. Imaging in the context of spinal trauma is currently guided by certain decision trees such as those reported by some Canadian studies (NEXUS, CCR) [17], identifying the type of imaging to be requested.…”

Section: Discussionmentioning

confidence: 99%

Untitled

2020

ASSE

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Introduction: Higher grade of injury of the subaxial spine is any osteo-disco-ligamentary injury clinically classified as ASIA A and B, very often involving the functional and vital prognosis of the patient. In African literature, few works have attempted to focus on this problem. The objective of this study is to evaluate the prognosis of patients with high grade of cervical spine trauma.Patients and methods: Over a 10-year period from 2009 to 2019, we retrospectively studied 48 records of patients followed in the neurosurgery department of the Fann University Hospital with higher grade of injury to the subaxial spine.Results: Higher grade forms of subaxial spine injuries were frequent and represented 32% of subaxial spine injuries. The average age was 35 years with extremes of 16 to 60 years. We found predominance of males, with a sex ratio of 15, and falls were common cause. All patients presented a severe neurological, i.e. 81% classified as ASIA A. Associated injuries such as head trauma were observed in 6.25%. Surgical treatment was performed in 44%, by anterior approach in the majority. Mortality was high, at 79%. Only one patient had a complete recovery among the 10 survivorsafter 12 months of follow-up. Conclusion:The improvement of the technical platform in the pre-hospital and hospital management of higher grade of injury of the subaxial spine and the creation of secondary neurosurgical care centers can improve the functional and vital prognosis. However, prevention remains the basis and constitutes the best treatment, while at the same time raising the awareness of the population.

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Section: Discussionmentioning

confidence: 99%

Untitled

2020

ASSE

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“…We used recommendations for the design and content validation of health instruments to develop a tool to identify potentially low-value injury admissions from the Québec trauma registry 13 . First, a trauma registry specialist, a trauma researcher and a trauma clinical expert used published literature [14][15][16][17][18][19][20][21][22] and their knowledge on trauma systems to select and define criteria consistent with patients not requiring hospitalisation (Supplemental Digital Content 1). For example, minor injury defined as a maximum Abbreviated Injury Scale (AIS) score [?]…”

Section: Selection Of Criteria To Identify Low-value Injury Admissionsmentioning

confidence: 99%

Low-value injury admissions in an integrated Canadian trauma system: a multicenter cohort study

Gagnon

Bérubé

Mercier³

et al. 2021

Preprint

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Background: Injury represents 260,000 hospitalisations and $27 billion in healthcare costs each year in Canada. Evidence suggests that there is significant variation in the prevalence of hospital admissions among ED presentations between countries and providers but we lack data specific to injury admissions. We aimed to estimate the prevalence of potentially low-value injury admissions following injury in a Canadian provincial trauma system, identify diagnostic groups contributing most to low-value admissions and assess inter-hospital variation. Methods: We conducted a retrospective multicenter cohort study based on all injury admissions in the Québec trauma system (2013-2018). Using literature and expert consultation, we developed criteria to identify potentially low-value injury admissions. We used a multilevel logistic regression model to evaluate inter-hospital variation in the prevalence of low-value injury admissions with intraclass correlation coefficients (ICC). We stratified our analyses by age (1-15; 16-64; 65-74; 75+ years). Results: The prevalence of low-value injury admissions was 16% (n=19,163) among all patients, 26% (2136) in children, 11% (4695) in young adults and 19% (12,345) in older adults. Diagnostic groups contributing most to low-value admissions were mild traumatic brain injury in children (48% of low-value pediatric injury admissions; n=922), superficial injuries (14%, n=660) or minor spinal injuries (14%, n=634) in adults aged 16-64, and superficial injuries in adults aged 65+ (22%, n=2771). We observed strong inter-hospital variation in the prevalence of low-value injury admissions (ICC=37%). Conclusion: One out of six hospital admissions following injury may be of low-value. Children with mild traumatic brain injury and adults with superficial injuries could be good targets for future research efforts seeking to reduce health care services overuse. Inter-hospital variation indicates there may be an opportunity to reduce low-value injury admissions with appropriate interventions targeting modifications in care processes.

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“…13 First, our project advisory committee (ED physician, critical care physician, trauma surgeon, trauma team leader, trauma care coordinator and a trauma registry specialist) developed the following working definition of a low-value injury admission: a patient admitted to hospital with a primary diagnosis of injury who has minor injuries not requiring any interventions that can only be conducted in hospital. Then, the advisory committee used published literature [14][15][16][17][18][19][20][21][22] and their knowledge on trauma systems to select and define criteria consistent with patients not requiring hospitalisation (Supporting Digital Content 1). For example, minor injury is defined as a maximum Abbreviated Injury Scale (AIS) score ≤ 2 and the absence of interventions requiring hospitalisation, such as a surgery.…”

Section: Selection Of Criteria To Identify Low-value Injury Admissionsmentioning

confidence: 99%

Low‐value injury admissions in an integrated Canadian trauma system: A multicentre cohort study

et al. 2021

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Background: Injury represents 260 000 hospitalisations and $27 billion in healthcare costs each year in Canada. Evidence suggests that there is significant variation in the prevalence of hospital admissions among emergency department presentations between countries and providers, but we lack data specific to injury admissions. We aimed to estimate the prevalence of potentially low-value injury admissions following injury in a Canadian provincial trauma system, identify diagnostic groups contributing most to low-value admissions and assess inter-hospital variation. Methods:We conducted a retrospective multicentre cohort study based on all injury admissions in the Québec trauma system (2013)(2014)(2015)(2016)(2017)(2018). Using literature and expert consultation, we developed criteria to identify potentially low-value injury admissions. We used a multilevel logistic regression model to evaluate inter-hospital variation in the prevalence of low-value injury admissions with intraclass correlation coefficients (ICC). We stratified our analyses by age (1-15; 16-64; 65-74; 75+ years). Results:The prevalence of low-value injury admissions was 16% (n = 19 163) among all patients, 26% (2136) in children, 11% (4695) in young adults and 19% (12 345) in older adults. Diagnostic groups contributing most to low-value admissions were mild traumatic brain injury in children (48% of low-value paediatric injury admissions; n = 922), superficial injuries (14%, n = 660) or minor spinal injuries (14%, n = 634) in adults aged 16-64 and superficial injuries in adults aged 65+ (22%, n = 2771). We observed strong inter-hospital variation in the prevalence of low-value injury admissions (ICC = 37%). Conclusion:One out of six hospital admissions following injury may be of low value.Children with mild traumatic brain injury and adults with superficial injuries could be good targets for future research efforts seeking to reduce healthcare services overuse. Inter-hospital variation indicates there may be an opportunity to reduce low-value injury admissions with appropriate interventions targeting modifications in care processes.

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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

Cited by 13 publications

References 22 publications

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Low-value injury admissions in an integrated Canadian trauma system: a multicenter cohort study

Low‐value injury admissions in an integrated Canadian trauma system: A multicentre cohort study

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