goglsweb.blogg.se - Canadian c spine rules

In our department, physicians are encouraged to use at least one rule before sending patients to perform CSR. Furthermore, Zoe et al in a meta-analysis of 15 studies demonstrated that despite their high sensitivity, these rules have low specificity. This debate between the NEXUS and the Canadian group may have decreased the reliably of physician to these rules. The Canadian team have published controversial studies showing the superiority of CCR. The most common reason for not using the CCR was that it is too difficult to remember and use in daily practice. The most common reason cited for not using the NEXUS rules in this study was patient insistence on obtaining a radiograph. In a survey send to 61 Massachusetts emergency physicians, Weiner S et al reported that only 56% and 10% of them recognized using the NEXUS and CCR rules respectively in their current practices.

The present study revealed that the Nexus and the CCR rules are well applied in our emergency department. The second objective was to assess the quality of CSR performed in emergency settings. The aim of this study was to evaluate retrospectively the compliance of our emergency physicians to these recommendations. While these rules are widely accepted, their current application and results are poorly studied. This rule uses 3 high-risk criteria (age 65 year or older, dangerous mechanism, paresthesias in the extremities), 5 low criteria (simple rear-end motor vehicle crash, sitting position in emergency department, ambulatory at any time, delayed onset of neck pain, and absence of midline C –spine tenderness), and the ability of patients to actively rotate their necks, to determine the need for CSR ( Figure 1). The second decision rule was the Canadian Cervical-Spine Rule (CCR) developed in 2001 in ten Canadian emergency departments. In 1992, The National Emergency X-Radiography Utilization Study (NEXUS) Low-Risk Criteria (NLC) developed one simple decision making instrument based on five clinical criteria ( Table 1) that can help physicians to identify reliably the patients who need CSR after blunt trauma. Two decision rules have been developed independently to permit more selective ordering of CSR, more rapid ruling out of injury to the cervical for patients, decrease patients’ exposure to ionizing radiation and economic losses.

Missing a cervical-spine fracture is an obsession of many emergency departments’ physicians, leading to unnecessary cervical-spine radiography (CSR). 2001 Oct 17 286(15):1841-8.Cervical blunt trauma is major health problem in developed countries.

The Canadian C-spine rule for radiography in alert and stable trauma patients. Also, actual implementation in practice has been studied. It was subsequently validated by this group and others.

(3) is the patient able to actively rotate neck 45 degrees to the left and right?.

(2) is there any low-risk factor present that allows safe assessment of range of motion (ie, simple rear-end motor vehicle collision, sitting position in ED, ambulatory at any time since injury, delayed onset of neck pain, or absence of midline C-spine tenderness)?.

(1) is there any high-risk factor present that mandates radiography (ie, age >/=65 years, dangerous mechanism, or paresthesias in extremities)?.

This was the derivation study, which came up with the following 3 questions with 100% sensitivity and 42.5% specificity for clinically important c-spine injuries. There are a lot of exclamation points in that song! This was a prospective convenience sample of 8924 adult patients with blunt trauma who were slated to undergo c-spine imaging. Then, just as in hockey, Canada took on the US and won when the Canadian and NEXUS rules were compared head to head. This rule came out the following year, with lead author Ian Stiell (aka and seemed to have better performance. We covered NEXU S, which came out in 2000. If we could clear the c-spine clinically using the history and exam, and this was a safe practice, it would be better than getting an x-ray or CT.

It allows clinical clearance of more people.Ĭ-spine imaging is costly, time consuming for patients, and exposes them to radiation. The Canadian C-spine rule has high sensitivity for c-spine injury and higher specificity than the NEXUS rule.