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The NEXUS criteria are insufficient to exclude cervical spine fractures in older blunt trauma patients

  • Gabriel Paykin
    Affiliations
    Department of Epidemiology & Preventive Medicine, Monash University, Melbourne, Australia

    National Trauma Research Institute, The Alfred Hospital, Melbourne, Australia

    Emergency & Trauma Centre, The Alfred Hospital, Melbourne, Australia
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  • Gerard O’Reilly
    Affiliations
    Department of Epidemiology & Preventive Medicine, Monash University, Melbourne, Australia

    National Trauma Research Institute, The Alfred Hospital, Melbourne, Australia

    Emergency & Trauma Centre, The Alfred Hospital, Melbourne, Australia
    Search for articles by this author
  • Helen M. Ackland
    Affiliations
    Department of Epidemiology & Preventive Medicine, Monash University, Melbourne, Australia

    National Trauma Research Institute, The Alfred Hospital, Melbourne, Australia

    Intensive Care Department, The Alfred Hospital, Melbourne, Australia
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  • Biswadev Mitra
    Correspondence
    Corresponding author at: National Trauma Research Institute, Level 4, 89 Commercial Rd, Melbourne, VIC 3004, Australia.
    Affiliations
    Department of Epidemiology & Preventive Medicine, Monash University, Melbourne, Australia

    National Trauma Research Institute, The Alfred Hospital, Melbourne, Australia

    Emergency & Trauma Centre, The Alfred Hospital, Melbourne, Australia
    Search for articles by this author
Published:February 23, 2017DOI:https://doi.org/10.1016/j.injury.2017.02.013

      Abstract

      Background and objective

      The National Emergency X-Radiography Utilization Study (NEXUS) criteria are used to assess the need for imaging to evaluate cervical spine integrity after injury. The aim of this study was to assess the sensitivity of the NEXUS criteria in older blunt trauma patients.

      Methods

      Patients aged 65 years or older presenting between 1st July 2010 and 30th June 2014 and diagnosed with cervical spine fractures were identified from the institutional trauma registry. Clinical examination findings were extracted from electronic medical records. Data on the NEXUS criteria were collected and sensitivity of the rule to exclude a fracture was calculated.

      Results

      Over the study period 231,018 patients presented to The Alfred Emergency & Trauma Centre, of whom 14,340 met the institutional trauma registry inclusion criteria and 4035 were aged ≥65 years old. Among these, 468 patients were diagnosed with cervical spine fractures, of whom 21 were determined to be NEXUS negative. The NEXUS criteria performed with a sensitivity of 94.8% [95% CI: 92.1%–96.7%] on complete case analysis in older blunt trauma patients. One-way sensitivity analysis resulted in a maximum sensitivity limit of 95.5% [95% CI: 93.2%–97.2%].

      Conclusion

      Compared with the general adult blunt trauma population, the NEXUS criteria are less sensitive in excluding cervical spine fractures in older blunt trauma patients. We therefore suggest that liberal imaging be considered for older patients regardless of history or examination findings and that the addition of an age criterion to the NEXUS criteria be investigated in future studies.

      Keywords

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