Prevalence of midline cervical spine tenderness in the non-trauma population

2021 ◽  
pp. emermed-2021-211288
Author(s):  
J Scott Delaney ◽  
Ammar Al-Kashmiri ◽  
Abdulaziz Alalshaikh ◽  
Saif Al-Ghafri ◽  
Sanjeet Singh Saluja ◽  
...  
Keyword(s):  
Cervical Spine ◽  
Decision Rules ◽  
Clinical Decision ◽  
Neck Trauma ◽  
Factors Associated ◽  
Trauma Population ◽  
Spine Imaging ◽  
High Prevalence ◽  
National Emergency ◽  
Upper Third

ObjectiveThe Canadian C-Spine Rule (CCR) and the National Emergency X-Radiography Utilization Study (NEXUS) criteria are two commonly used clinical decision rules which use midline cervical spine (c-spine) tenderness on palpation as an indication for c-spine imaging post-trauma. This study was undertaken to determine the prevalence and location of midline c-spine tenderness in the non-trauma population.MethodsWe prospectively evaluated consenting adult patients presenting to an urban ED or university sport medicine clinic in Montreal, Canada between 2018 and 2020 for atraumatic non-head and neck-related reports over a 20-month period. The presence and location of pain during midline c-spine palpation as assessed by two examiners during separate evaluations was recorded. Patient information such as age, neck length and circumference, gender, body mass index (BMI) and scaphoid tenderness was also collected.ResultsOf 478 patients enrolled, 286 (59.8%) had midline c-spine tenderness on palpation with both examiners. The majority of those with tenderness were female (70.6%). When examining all patients, tenderness was present in the upper third of the c-spine in 128 (26.8%) patients, middle third in 270 (56.5%) patients and lower third in 6 (1.3%) patients. Factors associated with having increased odds of midline c-spine tenderness on palpation included a lower BMI and the presence of scaphoid tenderness on palpation.ConclusionsThere is a high prevalence of c-spine tenderness on palpation in patients who have not undergone head or neck trauma. This finding may help explain the low specificity in some of the validation studies examining the CCR and the NEXUS criteria.

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

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.

scholarly journals A clinical decision rule for cervical spine CT in head or neck trauma patients

2013 ◽  
Vol 24 (4) ◽  
pp. 192-199 ◽  
Author(s):  
Takeshi Inagaki ◽  
Akio Kimura ◽  
Akiyoshi Hagiwara ◽  
Ryo Sasaki ◽  
Takuro Shimbo
Keyword(s):  
Cervical Spine ◽  
Decision Rule ◽  
Clinical Decision ◽  
Trauma Patients ◽  
Clinical Decision Rule ◽  
Neck Trauma ◽  
Spine Ct

High prevalence of ascending aortic dilation in adults with repaired coarctation of the aorta

2021 ◽  
pp. 1-6
Author(s):  
Daniel Rinnström ◽  
Mikael Dellborg ◽  
Ulf Thilén ◽  
Peder Sörensson ◽  
Niels-Erik Nielsen ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Aortic Valve ◽  
Aortic Valve Disease ◽  
Congenital Heart ◽  
Coarctation Of The Aorta ◽  
Valve Disease ◽  
Aortic Dilation ◽  
Factors Associated ◽  
High Prevalence ◽  
Life Threatening

Abstract Background: Ascending aortic dilation is a feared complication in adults with repaired coarctation of the aorta, as the condition is associated with life-threatening complications such as aortic dissection and rupture. However, the data are currently limited regarding factors associated with ascending aortic dilation in these patients. Methods and results: From the national register of congenital heart disease, 165 adult patients (≥ 18 years old) with repaired coarctation of the aorta, and echocardiographic data on aortic dimensions, were identified (61.2% male, mean age 35.8 ± 14.5 years). Aortic dilation (aortic diameters > 2 SD above reference mean) was found in 55 (33.3%) of the 165 included patients, and was associated with manifest aortic valve disease in univariable logistic regression analysis (OR 2.44, 95% CI [1.23, 4.83]). Conclusions: Aortic dilation is common post-repair of coarctation of the aorta, and is associated with manifest aortic valve disease and thus indirectly with the presence of a bicuspid aortic valve. However, no association was found between aortic dilation and age or blood pressure.

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