Don't Stick Your NEXUS Out for Older Patients

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Don't stick your NEXUS out for older trauma patients
Sensitivity for NEXUS in blunt trauma patients over age 65 was only 94.8% in this large retrospective trauma registry study.  I agree with the authors that we need to liberally image older patients who may have c-spine injury.

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NEXUS was not as sensitive in patients older than 65.  These people need imaging.  Interestingly, the Canadian C-spine rule takes age >65 into account.  Canada 2; United States 0.


Abstract

Injury. 2017 Feb 22. pii: S0020-1383(17)30084-0. doi: 10.1016/j.injury.2017.02.013. [Epub ahead of print]

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

Paykin G1, O'Reilly G1, Ackland HM2, Mitra B3.

Author information:

1 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.

2 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.

3 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. Electronic address: Biswadev.mitra@monash.edu.

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 ≥65years 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.

Copyright © 2017 Elsevier Ltd. All rights reserved.

PMID: 28274471