Canadian C-spine Rule and the National Emergency X-Radiography Utilization Low-Risk Criteria for C-spine radiography in young trauma patients
Section snippets
Methods
This study was approved by the University of Michigan's Institutional Review Board (Ann Arbor, Mich). It is a retrospective case-matched design with trauma patients 10 years or younger. The University of Michigan CS Mott Children's Hospital is an American College of Surgeons-verified level I pediatric trauma center. The pediatric trauma registry from 2005 to 2007 was used to identify the patients. The pediatric trauma registry records all hospital trauma patients younger than 18 years.
Results
Between 2005 and 2007, 1307 pediatric trauma patients were identified for review. For 318 patients (24.3%), radiographic imaging was performed to rule out a possible CSI. Of these, 125 were 10 years or younger and comprised cohort A. Nine hundred eighty-nine patients did not undergo cervical spine imaging of which 150 children 10 years or younger were randomly identified from the trauma registry. This comprised cohort B. Injury characteristics are shown in Table 2. Seven patients (3%) had
Discussion
Clinical decision rules help clinicians make diagnostic and therapeutic decisions at the bedside. They are derived from original research and incorporate 3 or more variables from the history, examination, or simple tests [6], [7], [8]. Clinical decision rules have been developed for ankle injuries, deep vein thrombosis, and for patients who have pneumonia [6], [7], [18], [19], [20], [21]. There are 3 stages in developing a CDR. The first stage is to create/derive the rule; the second stage
References (27)
- et al.
Characteristics of pediatric cervical spine injuries
J Pediatric Surg
(2001) - et al.
Cervical spine injuries in children: a review of 103 patients treated consecutively at a level I pediatric trauma center
J Pediatric Surg
(2001) Facilitating cervical spine radiography in blunt trauma
Emerg Med Clin North Am
(1991)Cervical radiography in the emergency department: who when how extensive?
J Pediatric Surg
(1993)- et al.
Low-risk criteria for cervical spine radiography in blunt trauma: a prospective study
Ann Emerg Med
(1992) - et al.
The Canadian CT head rule for patients with minor head injury
Lancet
(2001) - et al.
Test performance of the individual NEXUS low -risk clinical screening criteria for cervical spine injury
Ann Emerg Med
(2001) - et al.
The pediatric cervical spine: developmental anatomy and clinical aspects
J Emerg Med
(1989) - et al.
Interrater reliability of cervical spine injury criteria in patients with blunt trauma
Ann Emerg Med
(1998) - et al.
National Hospital Ambulatory Medical Care Survey: 2000 Advance data from vital statistics. National Center for Health Statistics. 326
(2002)
Clinical prediction rules: a review and suggested modifications of methodological standards
JAMA
Users' guides to the medical literature: XXII: how to use articles about clinical decision rules. Evidence-Based Medicine Working Group
JAMA
Methodologic standards for the development of clinical decision rules in emergency
Ann Emerg Med
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2021, Journal of Clinical Orthopaedics and TraumaCitation Excerpt :Garton et al. reported no missed injuries in patients above 8 years in contrast to 6% missed injuries in patients less than 8 years of age when evaluated using the NEXUS criteria.43 Ehrlich et al. reported a sensitivity of 43% and 86% for NEXUS and CCR respectively and concluded none of the protocols can be applied to paediatric age group.44 Pieretti-Vanmarcke in a multi-centre review of 12,537 patients with age less than three years concluded four predictors of cervical spine injury in these patients - GCS < 14; GCSeye = 1; motor vehicle crash; age 2–3 years.
Cervical spine evaluation in pediatric trauma: A cost-effectiveness analysis
2020, American Journal of Emergency MedicineCitation Excerpt :There is considerable variation in the evaluation of pediatric c-spine injury and a paucity of pediatric evidence to demonstrate the efficacy of national guidelines and decision rules to help guide clinicians [12]. Efforts to validate the NEXUS criteria in children found wide confidence intervals in sensitivity and specificity, leading to weaker recommendations regarding their application [52,63,64]. Without validated guidelines, clinicians choose from multiple strategies for evaluation and often combine aspects of clinical decision rules with risk-stratified imaging choices.
Frequency of Cervical Spine Injuries in Pediatric Craniomaxillofacial Trauma
2019, Journal of Oral and Maxillofacial SurgeryCitation Excerpt :In consequence, it is important to use low-dose radiation protocols or clinical decision-making tools to identify high-risk patients for imaging studies. Previous attempts at developing adult clinical decision rules and risk stratification for screening for CSIs, such as the NEXUS and CCS, are promising but not used because of lack of supporting evidence38 and require further refinement for pediatric populations. The present study has several limitations that warrant consideration.
Head and Cervical Spine Evaluation for the Pediatric Surgeon
2017, Surgical Clinics of North AmericaCitation Excerpt :A combination of the NEXUS and CCR can be used. At minimum, screening cervical spine imaging should be obtained in all unconscious children and conscious children who present with the following78,84,86: After a fall from 10 feet or greater (or body height if <8 years)
Presented at the 40th Annual CAPS Meeting, August 21-24, 2008, Toronto, Ontario, Canada.