The Canadian C-Spine Rule versus the NEXUS Low-Risk Criteria in Patients with Trauma

Stiell, Ian G.; Clement, Catherine M.; McKnight, R. Douglas; Brison, Robert J.; Schull, Michael J.; Rowe, Brian H.; Worthington, James; Eisenhauer, Mary A.; Cass, Daniel T.; Greenberg, Gary H.; MacPhail, Iain; Dreyer, Jonathan; Lee, Jacques; Bandıera, Glen; Reardon, Mark; Holroyd, Brian R.; Lesiuk, Howard; Wells, George A.

doi:10.1056/nejmoa031375

Cited by 572 publications

(320 citation statements)

References 33 publications

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“…These methods have been used in other high calibre decision rule studies. [32][33][34][35] Our study also has potential limitations. The outcome "urological intervention" can vary among urologists in different geographic areas and may be influenced by independent patient factors such as associated ureteral pathology, patient occupation and patient preference.…”

Section: Discussionmentioning

confidence: 92%

Predicting intervention in renal colic patients after emergency department evaluation

Papa

Stiell

Wells

et al. 2005

CJEM

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Objectives:There is no set of prospectively validated criteria to identify the emergency department (ED) patients with renal colic who are most likely to eventually have to undergo an intervention. This study prospectively assessed predictors of intervention in this patient population. Methods: This prospective cohort study included adult patients with renal colic who presented to 2 tertiary care hospital EDs. Patients had an 18-variable data form completed by an emergency physician and a radiological study to confirm urolithiasis. After discharge, patients were followed at 1 and 4 weeks to assess for intervention. The outcome criteria included the patient having had at least 1 of the following procedures performed: extracorporeal shockwave lithotripsy (ESWL), ureteroscopy, percutaneous nephrostomy or open surgery. Data were analyzed using appropriate univariate techniques, and those variables associated with intervention were combined using logistic regression analysis. Results: Over an 8-month period, 245 patients with confirmed urolithiasis were followed; 20% (95% confidence interval [CI] 15%-25%) eventually had a procedure to remove their calculi. Three variables were significantly correlated with having a procedure: i) size of calculus ≥ 6 mm (odds ratio [OR] 10.7, 95% CI 4.6-24.8), ii) location of calculus above mid-ureter (OR 6.9, 95% CI 3.0-15.9), and iii) Visual Analogue Scale score for pain at discharge from the ED ≥ 2 cm (OR 2.6, 95% CI 1.0-6.8). The area under receiver operating characteristic curve was 0.77 (95% C I 0.70-0.84) (p < 0.001). If all variables were present there was a 90% probability of the patient having an intervention performed within 4 weeks of discharge from the ED. Conversely, if none of the variables were present there was only a 4% probability of an intervention. Overall, the model had a sensitivity of 92% (95% CI 89%-96%) and a specificity of 63% (95% CI 57%-69%). Conclusions: This study has identified variables that could potentially be used to identify those renal colic patients who require an intervention after ED evaluation. Future studies will prospectively validate this model. RÉSUMÉObjectifs : Il n'existe pas d'ensemble de critères validés prospectivement pour identifier les patients reçus au département d'urgence pour une colique néphrétique qui sont les plus susceptibles EM ADVANCES • INNOVATIONS EN MU

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Section: Discussionmentioning

confidence: 92%

Predicting intervention in renal colic patients after emergency department evaluation

Papa

Stiell

Wells

et al. 2005

CJEM

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“…2 In 2003, the prospective validation demonstrated a sensitivity of 99.4% and a specificity of 40.4% for detecting clinically important cervical spine injuries in 8,283 patients. 3 The Canadian computed tomography (CT) Head Rule (CCHR) uses five high-risk criteria and two medium-risk criteria to determine the need for CT in patients with minor head injury (Figure 2). It was derived in 2001 in a multicenter prospective cohort study involving 3,121 patients who presented to the ED following blunt trauma to the head with a GCS score of 13-15.…”

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confidence: 99%

“…5 The derivation and validation of the CCR and CCHR were published in prominent general medical journals. [2][3][4][5] Nevertheless, it is far from clear that publication within the medical literature influences clinician knowledge or is subsequently translated into use. 6,7 Little is known about factors that determine widespread adoption of clinical decision rules into mainstream practice.…”

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confidence: 99%

International Survey of Emergency Physicians’ Awareness and Use of the Canadian Cervical‐Spine Rule and the Canadian Computed Tomography Head Rule

Eagles

Stiell

Clement

et al. 2008

Academic Emergency Medicine

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Objectives: The derivation and validation studies for the Canadian Cervical-Spine (C-Spine) Rule (CCR) and the Canadian Computed Tomography (CT) Head Rule (CCHR) have been published in major medical journals. The objectives were to determine: 1) physician awareness and use of these rules in Australasia, Canada, the United Kingdom, and the United States and 2) physician characteristics associated with awareness and use.Methods: A self-administered e-mail and postal survey was sent to members of four national emergency physician (EP) associations using a modified Dillman technique. Results were analyzed using repeatedmeasures logistic regression models.Results: The response rate was 54.8% (1,150 ⁄ 2,100). Reported awareness of the CCR ranged from 97% (Canada) to 65% (United States); for the CCHR it ranged from 86% (Canada) to 31% (United States). Reported use of the CCR ranged from 73% (Canada) to 30% (United States); for the CCHR, it was 57% (Canada) to 12% (United States). Predictors of awareness were country, type of rule, full-time employment, younger age, and teaching hospital (p < 0.05). Significant differences in use of the CCR by country were observed, but not for the CCHR. Teaching hospitals were more likely to use the CCR than nonteaching hospitals, but less likely to use the CCHR.Conclusions: This large international study found notable differences among countries with regard to knowledge and use of the CCR and CCHR. Awareness and use of both rules were highest in Canada and lowest in the United States. While younger physicians, those employed full-time, and those working in teaching hospitals were more likely to be aware of a decision rule, age and employment status were not significant predictors of use. A better understanding of factors related to awareness and use of emergency medicine (EM) decision rules will enhance our understanding of knowledge translation and facilitate strategies to enhance dissemination and implementation of future rules.

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“…At the time of injury, the average age of patients with traumatic spine lesions is 32 years and 55% of those injured are aged [16][17][18][19][20][21][22][23][24][25][26][27][28][29][30] years. Approximately, half of spinal injuries occur in the cervical spine, the other half involves the thoracic, lumbar, and sacral areas.…”

Section: Introductionmentioning

confidence: 99%

Trauma of the spine and spinal cord: imaging strategies

et al. 2009

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Traumatic injuries of the spine and spinal cord are common and potentially devastating lesions. We present a comprehensive overview of the classification of vertebral fractures, based on morphology (e.g., wedge, (bi)concave, or crush fractures) or on the mechanism of injury (flexion-compression, axial compression, flexiondistraction, or rotational fracture-dislocation lesions). The merits and limitations of different imaging techniques are discussed, including plain X-ray films, multi-detector computed tomography (MDCT), and magnetic resonance imaging (MRI) for the detection. There is growing evidence that state-of-the-art imaging techniques provide answers to some of the key questions in the management of patients with spine and spinal cord trauma: is the fracture stable or unstable? Is the fracture recent or old? Is the fracture benign or malignant? In summary, we show that high-quality radiological investigations are essential in the diagnosis and management of patients with spinal trauma.

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The Canadian C-Spine Rule versus the NEXUS Low-Risk Criteria in Patients with Trauma

Abstract: For alert patients with trauma who are in stable condition, the CCR is superior to the NLC with respect to sensitivity and specificity for cervical-spine injury, and its use would result in reduced rates of radiography.

Cited by 572 publications

References 33 publications

Predicting intervention in renal colic patients after emergency department evaluation

Predicting intervention in renal colic patients after emergency department evaluation

International Survey of Emergency Physicians’ Awareness and Use of the Canadian Cervical‐Spine Rule and the Canadian Computed Tomography Head Rule

Trauma of the spine and spinal cord: imaging strategies

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