Over the hill and falling down: Can the NEXUS criteria be applied to the elderly?

Jambhekar, Amani; Lindborg, Ryan; Chan, Vincent; Fulginiti, Adriana; Fahoum, Bashar; Rucinski, James

doi:10.1016/j.ijsu.2017.12.009

Cited by 4 publications

(2 citation statements)

References 20 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Numerous other countries have since adopted the same approach [17]. However, attention has been focused on NEXUS‐negative patients, but many trauma patients are in fact NEXUS‐positive [18]. As seen in the current study, it is important to note that common reasons for being NEXUS‐positive include intoxication or intubation, which has not been correlated with cervical spine injury [3].…”

Section: Discussionmentioning

confidence: 82%

Cervical Spine Clearance in Trauma Patients with an Unreliable Physical Examination

et al. 2019

View full text Add to dashboard Cite

Background The objective of this study was to describe and compare the timing of cervical spine clearance in trauma patients with an unreliable physical examination. Methods We prospectively included adult trauma patients admitted with a cervical collar and an unreliable clinical examination (as defined by the NEXUS criteria) at two level 1 trauma centers: one in the USA (US) and one in Denmark (DK). We excluded patients with cervical spine injuries requiring a collar or surgery as treatment and patients with a collar placed after hospital arrival. The primary outcome was time from emergency department (ED) arrival to collar removal. Secondary outcomes included time to CT of the cervical spine (CTCS). At the US trauma center, an institutional protocol allowing cervical spine clearance exclusively by CTCS was in place. At the Danish trauma center, cervical spine clearance was based on a clinical evaluation by an orthopedic surgeon, usually after CTCS.Results A total of 113 patients were included (US: n = 56; DK: n = 57). The median age was 47 years, and 68% were males. The main reasons for an unreliable physical examination were a Glasgow Coma Scale score below 14 (35%), distracting injuries (26%), cervical spine tenderness (13%) and intoxication (13%). The injury severity score at the US trauma center was higher than at the DK trauma center (median: 17 vs. 11, p = 0.03). Both time to CTCS (median: 41 vs. 18 min, p \ 0.0001) and time to collar removal (median: 1042 vs. 49 min, p \ 0.0001) were significantly greater at the US trauma center. Conclusions Time to collar removal was significantly greater in a trauma center utilizing a cervical spine clearance protocol based on CTCS. As patients may develop complications related to the collar, future studies should clarify how early removal can be implemented without increasing the risk of morbidity.

show abstract

Section: Discussionmentioning

confidence: 82%

Cervical Spine Clearance in Trauma Patients with an Unreliable Physical Examination

et al. 2019

View full text Add to dashboard Cite

show abstract

“…The validation of the criteria in the original study has led to its widespread use despite concerns about its effectiveness in some groups. Specifically, concerns have been raised about the sensitivity of the criteria in elderly and pediatric patients [ 7 , 8 ].…”

Section: Introductionmentioning

confidence: 99%

Implementation of National Emergency X-Radiography Utilization Study (NEXUS) Criteria in Pediatrics: A Systematic Review

Ekhator¹,

Nwankwo²,

Nicol³

2022

Cureus

View full text Add to dashboard Cite

Since its introduction in 1992, the National Emergency X-Radiography Utilization Study (NEXUS) criteria have been used in trauma to decide whether a patient requires radiographic imaging. The tool is important in reducing radiation exposure. However, applying the NEXUS criteria for cervical spine imaging in pediatric patients is poorly supported compared to their use in adults. The objective of this review was to examine the effectiveness of using the NEXUS criteria in the diagnostic management of pediatric cervical spine injuries (CSI). The following databases were searched for studies focused on applying the NEXUS criteria for CSI in pediatric patients: Cochrane, PubMed, Google Scholar, EMBASE, ELSEVIER, and ScienceDirect. Additional studies were found through reference lists of primary sources and previous systematic and meta-analyses. The search focused on randomized controlled trials (RCTs), cohort studies, retrospective studies, prospective studies, and other uncontrolled trials published from 2000 to 2022. There were seven included studies with a total of 4502 pediatric patients. Five of the included studies were retrospective studies, while the remaining were prospective and case studies. Our results show that the sensitivity ranged from 43% to 100%, while the specificity ranged from 12.93% to 96%. The sensitivity increased with age, with those under the age of two or under the age of eight reporting poorer outcomes than the older pediatric patients. One study also shows that the proportion of patients undergoing cervical spine CT increased from 18% to 61% in the initial period before the implementation of clearance guidelines. The implementation of guidelines led to a 23% decrease in CT scans clearable by NEXUS criteria after 12 months. One of the studies reported that NEXUS criteria were a cost-effective option when used along with X-rays and CT. Overall, the studies do not strongly support the application of the NEXUS criteria to image pediatric patients for CSI. In conclusion, there is weak support in the literature for applying the NEXUS criteria in determining the need for cervical spine imaging in pediatric trauma patients. The practice and research implications of the findings are also discussed.

show abstract

Geriatric clinical screening tool for cervical spine injury after ground-level falls

et al. 2021

View full text Add to dashboard Cite

BackgroundA consistent approach to cervical spine injury (CSI) clearance for patients 65 and older remains a challenge. Clinical clearance algorithms like the National Emergency X-Radiography Utilisation Study (NEXUS) criteria have variable accuracy and the Canadian C-spine rule excludes older patients. Routine CT of the cervical spine is performed to rule out CSI but at an increased cost and low yield. Herein, we aimed to identify predictive clinical variables to selectively screen older patients for CSI.MethodsThe University of Iowa’s trauma registry was interrogated to retrospectively identify all patients 65 years and older who presented with trauma from a ground-level fall from January 2012 to July 2017. The relationship between predictive variables (demographics, NEXUS criteria and distracting injuries) and presence of CSI was examined using the generalised linear modelling (GLM) framework. A training set was used to build the statistical models to identify clinical variables that can be used to predict CSI and a validation set was used to assess the reliability and consistency of the model coefficients estimated from the training set.ResultsOverall, 2312 patients ≥65 admitted for ground-level falls were identified; 253 (10.9%) patients had a CSI. Using the GLM framework, the best predictive model for CSI included midline tenderness, focal neurological deficit and signs of trauma to the head/face, with midline tenderness highly predictive of CSI (OR=22.961 (15.178–34.737); p<0.001). The negative predictive value (NPV) for this model was 95.1% (93.9%–96.3%). In the absence of midline tenderness, the best model included focal neurological deficit (OR=2.601 (1.340–5.049); p=0.005) and signs of trauma to the head/face (OR=3.024 (1.898–4.815); p<0.001). The NPV was 94.3% (93.1%–95.5%).ConclusionMidline tenderness, focal neurological deficit and signs of trauma to the head/face were significant in this older population. The absence of all three variables indicates lower likelihood of CSI for patients≥65. Future observational studies are warranted to prospectively validate this model.

show abstract

Over the hill and falling down: Can the NEXUS criteria be applied to the elderly?

Cited by 4 publications

References 20 publications

Cervical Spine Clearance in Trauma Patients with an Unreliable Physical Examination

Cervical Spine Clearance in Trauma Patients with an Unreliable Physical Examination

Implementation of National Emergency X-Radiography Utilization Study (NEXUS) Criteria in Pediatrics: A Systematic Review

Geriatric clinical screening tool for cervical spine injury after ground-level falls

Contact Info

Product

Resources

About