Applying clinical decision rules to paediatric cervical spine injuries: if at first you don’t succeed

Cervical spine injuries are frequent and often caused by a blunt trauma mechanism. They can have severe consequences, with a high mortality rate and a high rate of neurological lesions. Diagnosis is a three-step process: 1) risk assessment according to the history and clinical features, guided by a clinical decision rule such as the Canadian C-Spine rule; 2) imaging if needed; 3) classification of the injury according to different classification systems in the different regions of the cervical spine. The urgency of treatment is dependent on the presence of a neurological lesion and/or instability. The treatment strategy depends on the morphological criteria as defined by the classification. Cite this article: EFORT Open Rev 2018;3 DOI: 10.1302/2058-5241.3.170076

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Use of diagnostic imaging in the emergency department for cervical spine injuries in Kingston, Ontario

CJEM ◽

10.2310/8000.2013.131051 ◽

2014 ◽

Vol 16 (01) ◽

pp. 25-33

Author(s):

William Pickett ◽

Atif Kukaswadia ◽

Wendy Thompson ◽

Mylene Frechette ◽

Steven McFaull ◽

...

Keyword(s):

Cervical Spine ◽

Diagnostic Imaging ◽

Clinical Decision ◽

Neck Injury ◽

Spine Injury ◽

Cervical Spine Injuries ◽

Spine Injuries ◽

Cervical Spine Radiography ◽

Clinically Significant ◽

Over Time

ABSTRACTObjectives:This study assessed the use and clinical yield of diagnostic imaging (radiography, computed tomography, and medical resonance imaging) ordered to assist in the diagnosis of acute neck injuries presenting to emergency departments (EDs) in Kingston, Ontario, from 2002–2003 to 2009–2010.Methods:Acute neck injury cases were identified using records from the Kingston sites of the Canadian National Ambulatory Care Reporting System. Use of radiography was analyzed over time and related to proportions of cases diagnosed with clinically significant cervical spine injuries.Results:A total of 4,712 neck injury cases were identified. Proportions of cases referred for diagnostic imaging to the neck varied significantly over time, from 30.4% in 2002–2003 to 37.6% in 2009–2010 (ptrend= 0.02). The percentage of total cases that were positive for clinically significant cervical spine injury (“clinical yield”) also varied from a low of 5.8% in 2005–2006 to 9.2% in 2008–2009 (ptrend= 0.04), although the clinical yield of neck-imaged cases did not increase across the study years (ptrend= 0.23). Increased clinical yield was not observed in association with higher neck imaging rates whether that yield was expressed as a percentage of total cases positive for clinically significant injury (p= 0.29) or as a percentage of neck-imaged cases that were positive (p= 0.77).Conclusions:We observed increases in the use of diagnostic images over time, reflecting a need to reinforce an existing clinical decision rule for cervical spine radiography. Temporal increases in the clinical yield for total cases may suggest a changing case mix or more judicious use of advanced types of diagnostic imaging.

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Clinical Decision Rules and Cervical Spine Injury

Journal of Emergency Medicine ◽

10.1016/j.jemermed.2007.05.022 ◽

2008 ◽

Vol 34 (1) ◽

pp. 99-100

Author(s):

Thomas Barry ◽

Robert McNamara

Keyword(s):

Cervical Spine ◽

Cervical Spine Injury ◽

Decision Rules ◽

Clinical Decision ◽

Spine Injury ◽

Clinical Decision Rules

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Projected paediatric cervical spine imaging rates with application of NEXUS, Canadian C-Spine and PECARN clinical decision rules in a prospective Australian cohort

Emergency Medicine Journal ◽

10.1136/emermed-2020-210325 ◽

2021 ◽

Vol 38 (5) ◽

pp. 330-337

Author(s):

Natalie Phillips ◽

Katie Rasmussen ◽

Sally McGuire ◽

Kerrie-Ann Abel ◽

Jason Acworth ◽

...

Keyword(s):

Cervical Spine ◽

Decision Rules ◽

Clinical Decision ◽

Research Network ◽

Spine Injury ◽

X Rays ◽

Clinical Decision Rules ◽

Paediatric Emergency ◽

Spine Imaging ◽

Paediatric Emergency Care

BackgroundClinical decision rules (CDRs) are commonly used to guide imaging decisions in cervical spine injury (CSI) assessment despite limited evidence for their use in paediatric populations. We set out to determine CSI incidence, imaging rates and the frequency of previously identified CSI risk factors, and thus assess the projected impact on imaging rates if CDRs were strictly applied as a rule in our population.MethodsA single-centre prospective observational study on all aged under 16 years presenting for assessment of possible CSI to a tertiary paediatric emergency department over a year, commencing September 2015. CDR variables from the National Emergency X-Radiography Utilization Study (NEXUS) rule, Canadian C-Spine rule (CCR) and proposed Paediatric Emergency Care Applied Research Network (PECARN) rule were collected prospectively and applied post hoc.Results1010 children were enrolled; 973 had not received prior imaging. Of these, 40.7% received cervical spine imaging; 32.4% X-rays, 13.4% CT scan and 3% MRI. All three CDRs identified the five children (0.5%) with CSI who had not received prior imaging. If CDRs were strictly applied as a rule for imaging, projected imaging rates in our setting would be as follows: NEXUS-44% (95% CI 41% to 47.4%), CCR-at least 48.4% (95% CI 45.3% to 51.7%) and PECARN-68% (95% CI 65.1% to 71.1%).ConclusionCSIs were rare (0.5% of our cohort), however, 40% of children received imaging. CDRs have been designed to guide imaging decisions; if strictly applied as a rule for imaging, the CDRs assessed in this study would increase imaging rates. Projected rates differ considerably depending on the CDR applied. These findings highlight the need for a validated paediatric-specific cervical spine imaging CDR.

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Epidemiology of Cervical Spine Injuries in The Emergency Department at The University Hospital of The West Indies, Jamaica and The Use of Clinical Decision Rules, A Retrospective Review.

10.21203/rs.3.rs-570562/v1 ◽

2021 ◽

Author(s):

Olsheath Bowen (First Author) ◽

C Walters ◽

Eric Wilson Williams ◽

Leohrandra Graham ◽

Jean Williams-Johnson (last author)

Keyword(s):

Cervical Spine ◽

Motor Vehicle ◽

Decision Rules ◽

University Hospital ◽

The West ◽

Cervical Spine Injuries ◽

Vehicle Collision ◽

Spine Injuries ◽

The University ◽

Clinical Rules

Abstract Background: Cervical spine injuries are myriad and ubiquitous, however the related demographic information has not been documented for the Jamaican or Caribbean population. These injuries can be life threatening and so it is important for the Emergency Physician to adhere to guidelines which direct management decisions including the need for imaging. This study therefore is an effort to report on the epidemiology of patients with cervical spine injuries presenting to the Emergency Department (ED) at the University Hospital of the West Indies (UHWI) and the use of clinical rules in the diagnosis of these injuries.This was a retrospective study. The log books from the ED at the UHWI were used to identify patients presenting with possible cervical spine injuries from January 1, 2013 to December 31, 2016. Inclusion/exclusion criteria were applied to select study patients. Demographical and clinical information was collected and evaluated.Results: 1,380 charts were identified as possible subjects. Of these, 887 charts were located and 806 (90.9%) were eligible. Ages ranged from 16 to 101 years with an average of 37.5 years. The majority of subjects were male, with a male to female ratio of 3:1. The main causes of these injuries were motor-vehicle collision (46.4%), motor-bike collision (23.8%) and fall from elevation (13.1%). Cervical spine injuries were identified in 20 (2.48%) subjects where motor-vehicle collision (45%) and motor-bike collisions (25%) were the main cause for injuries. Documentation of clinical rules applied to determine the need for radiological testing were present for 37.7% of the study population (NEXUS 36.2%, CCR 0.4% and combination 1.1%)Conclusion: The main source of injuries was due to road traffic accidents. This suggests more needs to be done regarding road safety. There is also room for improvement as it relates to the use of decision rules which may reduce the occurrence of unnecessary imaging.

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