81: Use of a Clinical Sobriety Assessment Tool With the NEXUS Low-Risk Cervical Spine Criteria to Reduce Cervical Spine Imaging in Blunt Trauma Patients With Acute Alcohol or Drug Use: A Pilot Study

This chapter, found in the back pain section of the book, provides a succinct synopsis of a key study examining the use of cervical spine imaging in blunt trauma patients. This summary outlines the study methodology and design, major results, limitations and criticisms, related studies and additional information, and clinical implications. The study presents a set of five diagnostic criteria that approach 100% sensitivity for identifying clinically important cervical spine injuries and could eliminate one-eighth of all cervical spine radiographs ordered for these patients. In addition to outlining the most salient features of the study, a clinical vignette and imaging example are included in order to provide relevant clinical context.

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Evaluation of Cervical Spine Fracture in the Elderly: Can We Trust Our Physical Examination?

The American Surgeon ◽

10.1177/000313481408000228 ◽

2014 ◽

Vol 80 (2) ◽

pp. 182-184 ◽

Cited By ~ 16

Author(s):

Terral Goode ◽

Andrew Young ◽

Sean P. Wilson ◽

Judith Katzen ◽

Luke G. Wolfe ◽

...

Keyword(s):

Cervical Spine ◽

Blunt Trauma ◽

Predictive Value ◽

Assessment Tool ◽

The Elderly ◽

Spine Fracture ◽

Cervical Spine Fracture ◽

Trauma Patients ◽

Sensitivity Specificity ◽

National Emergency

The purpose of this trial was to compare National Emergency X-Radiography Utilization Study (NEXUS) criteria (NC) with computed tomography (CT) as the gold standard to evaluate cervical spine (C-spine) fractures in elderly blunt trauma patients. We prospectively compared adult blunt trauma patients 65 years or older (E) with younger than 65 years (NE), evaluating the sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of NC compared with CT in these two cohorts. A total of 2785 blunt trauma patients were included of whom 320 were E (average age, 75 years) and 2465 were NE (average age, 36 years). Incidence of C-spine fracture was 12.8 per cent (E) versus 7.4 per cent (NE) ( P = 0.002). Age was an independent predictor of fracture ( P = 0.01). NC had a sensitivity of 65.9 per cent in E and PPV of 19.3 per cent in E ( P = 0.001) versus a sensitivity of 84.2 per cent in NE and PPV of 10.6 per cent ( P < 0.0001). The specificity was 59.5 per cent for E versus 42.6 per cent for NE (NPV, 92.2% E vs 97.1% NE). This study suggests that NEXUS criteria are not an appropriate assessment tool when applied to severe blunt trauma patients, particularly in the elderly population who had more missed injures than their younger counterparts. CTshould be used in all blunt trauma patients regardless of whether they meet NEXUS criteria.

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Faculty Opinions recommendation of Plain radiography does not add any clinically significant advantage to multidetector row computed tomography in diagnosing cervical spine injuries in blunt trauma patients.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.1157915.617976 ◽

2009 ◽

Author(s):

Elfyn Thomas

Keyword(s):

Computed Tomography ◽

Cervical Spine ◽

Blunt Trauma ◽

Plain Radiography ◽

Multidetector Row Computed Tomography ◽

Trauma Patients ◽

Cervical Spine Injuries ◽

Multidetector Row ◽

Spine Injuries ◽

Clinically Significant

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40-Slice Multidetector CT: Is MRI Still Necessary for Cervical Spine Clearance after Blunt Trauma?

The American Surgeon ◽

10.1177/000313481007600207 ◽

2010 ◽

Vol 76 (2) ◽

pp. 157-163 ◽

Cited By ~ 11

Author(s):

Jay Menaker ◽

Deborah M. Stein ◽

Allan S. Philp ◽

Thomas M. Scalea

Keyword(s):

Cervical Spine ◽

Blunt Trauma ◽

Trauma Registry ◽

Clinical Symptoms ◽

Multidetector Ct ◽

Trauma Patients ◽

Mri Findings ◽

Persistent Symptoms ◽

Operative Repair ◽

Ct Technology

We have recently demonstrated that 16-slice multidetector CT (MDCT) is insufficient for cervical spine (CS) clearance in patients with unreliable examinations after blunt trauma. The purpose of this study was to determine if a negative CS CT using 40-slice MDCT is sufficient for ruling out CS injury in unreliable blunt trauma patients or if MRI remains necessary for definitive clearance. In addition, we sought to elucidate the frequency by which MRI alters treatment in patients with a negative CS CT who have a reliable examination with persistent clinical symptoms. The trauma registry was used to identify all patients with blunt trauma who had a negative CS CT on admission using 40-slice MDCT and a subsequent CS MRI during their hospitalization from July 2006 to July 2007. Two hundred thirteen patients were identified. Overall, 24.4 per cent patients had abnormal MRIs. Fifteen required operative repair; 23 required extended cervical collar; and 14 had collars removed. A total of 8.3 per cent of patients with an unreliable examination and 25.6 per cent of reliable patients had management changed based on MRI findings. Overall, MRI changed clinical practice in 17.8 per cent of all patients. Despite newer 40-slice CT technology, MRI continues to be necessary for CS clearance in patients with unreliable examinations or persistent symptoms.

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