Amani Jambhekar1, Ryan Lindborg2, Vincent Chan2, Adriana Fulginiti2, Bashar Fahoum2, James Rucinski2. 1. Department of Surgery, New York Presbyterian Brooklyn Methodist Hospital, Brooklyn, NY, USA. Electronic address: Amani.jambhekar@gmail.com. 2. Department of Surgery, New York Presbyterian Brooklyn Methodist Hospital, Brooklyn, NY, USA.
Abstract
INTRODUCTION: The National Emergency X-Radiography Utilization Study (NEXUS) criteria have been criticized due to the presumed unreliability of the clinical exam in elderly patients. The objective of this study was to determine if the NEXUS criteria can be safely applied to this vulnerable group of patients. METHODS: 596 trauma patients over the age of 65 were enrolled in a prospectively designed study between April 1, 2015 and October 1, 2016. The study was designed to encourage the use of the NEXUS criteria for all trauma patients including the elderly. NEXUS-negative patients (n = 226) were defined as individuals fulfilling none of the low risk criteria. The specificity and sensitivity of the NEXUS criteria were calculated based on any cervical spine injuries which were missed in NEXUS-positive patients (n = 129) who met one or more criteria. RESULTS: Out of the 596 included elderly patients, 355 patients underwent computed tomography (CT) of the cervical spine. 129 patients were NEXUS-positive and in this group ten nonoperative cervical spine injuries were detected. There were no NEXUS-positive patients who did not undergo CT scans of the cervical spine. No cervical spine injuries were detected in the 226 NEXUS-negative patients. In elderly patients, the NEXUS criteria had a sensitivity of 100% and specificity of 100%. CONCLUSION: The NEXUS criteria have been criticized in prior literature as less sensitive in elderly patients. Based on the current study, the use of the NEXUS criteria may lead to decreased radiation exposure and healthcare costs allowing for better allocation of resources for patients who warrant imaging of the cervical spine.
INTRODUCTION: The National Emergency X-Radiography Utilization Study (NEXUS) criteria have been criticized due to the presumed unreliability of the clinical exam in elderly patients. The objective of this study was to determine if the NEXUS criteria can be safely applied to this vulnerable group of patients. METHODS: 596 traumapatients over the age of 65 were enrolled in a prospectively designed study between April 1, 2015 and October 1, 2016. The study was designed to encourage the use of the NEXUS criteria for all traumapatients including the elderly. NEXUS-negative patients (n = 226) were defined as individuals fulfilling none of the low risk criteria. The specificity and sensitivity of the NEXUS criteria were calculated based on any cervical spine injuries which were missed in NEXUS-positive patients (n = 129) who met one or more criteria. RESULTS: Out of the 596 included elderly patients, 355 patients underwent computed tomography (CT) of the cervical spine. 129 patients were NEXUS-positive and in this group ten nonoperative cervical spine injuries were detected. There were no NEXUS-positive patients who did not undergo CT scans of the cervical spine. No cervical spine injuries were detected in the 226 NEXUS-negative patients. In elderly patients, the NEXUS criteria had a sensitivity of 100% and specificity of 100%. CONCLUSION: The NEXUS criteria have been criticized in prior literature as less sensitive in elderly patients. Based on the current study, the use of the NEXUS criteria may lead to decreased radiation exposure and healthcare costs allowing for better allocation of resources for patients who warrant imaging of the cervical spine.
Authors: Josefine S Baekgaard; Rasmus Ejlersgaard Christensen; Jae Moo Lee; Ahmed I Eid; Trine G Eskesen; Jacob Steinmetz; Lars S Rasmussen; David R King; George C Velmahos Journal: World J Surg Date: 2020-04 Impact factor: 3.352