Parisa Ghelichkhani1, Kavous Shahsavarinia2, Afshin Gharekhani3, Ali Taghizadieh4, Alireza Baratloo5,6, Fattah Hama Rahim Fattah7, Najmeh Abbasi8, Mohammed I M Gubari9, Gholamreza Faridaalee9, Hossein Dinpanah10, Mir Saeed Yekaninejad11, Alireza Esmaeili12, Michael E Jones13, Shaghayegh Askarian-Amiri14, Mahmoud Yousefifard15, Mostafa Hosseini16,17. 1. Department of Intensive Care Nursing, School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran. 2. Road Traffic Injury Research Center, Tabriz University of Medical Sciences, Tabriz, Iran. 3. Department of Clinical Pharmacy (Pharmacotherapy), Drug Applied Research Center, Tabriz University of Medical Sciences, Tabriz, Iran. 4. Tuberculosis and Lung Research Center, Tabriz University of Medical Sciences, Tabriz, Iran. 5. Pre-Hospital and Hospital Research Center, Tehran University of Medical Sciences, Tehran, Iran. 6. Department of Emergency Medicine, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran. 7. Community Medicine, College of Medicine, University of Sulaimani, Sulaimani, Iraq. 8. Department of Emergency Medicine, Maragheh University of Medical Sciences, Maragheh, Iran. 9. Community Health Department, Technical College of Health, Sulaimani Polytechnic University, Sulaimani, Iraq. 10. Emergency Department, 9-Day Hospital, Torbat Heydariyeh University of Medical Sciences, Torbat Heydariyeh, Iran. 11. Department of Epidemiology and Biostatistics School of Public Health, Tehran University of Medical Sciences, Poursina Ave, Tehran, Iran. 12. Department of Emergency Medicine, Shahid Sadoughi University of Medical Sciences, Yazd, Iran. 13. Division of Genetics and Epidemiology, The Institute of Cancer Research, London, UK. 14. Physiology Research Center, School of Medicine, Iran University of Medical Sciences, Hemmat Highway, Tehran, Iran. 15. Physiology Research Center, School of Medicine, Iran University of Medical Sciences, Hemmat Highway, Tehran, Iran. yousefifard.m@iums.ac.ir. 16. Department of Epidemiology and Biostatistics School of Public Health, Tehran University of Medical Sciences, Poursina Ave, Tehran, Iran. mhossein110@yahoo.com. 17. Pediatric Chronic Kidney Disease Research Center, University of Medical Sciences, Tehran, Iran. mhossein110@yahoo.com.
Abstract
PURPOSE: Although, Canadian C-spine rule and the National Emergency X-Radiography Utilization Study (NEXUS) criteria in ruling out clinically important cervical spine injuries have been validated using large prospective studies, no consensus exist as to which rule should be endorsed. Therefore, the aim of the present study was to compare the accuracy of the Canadian C-spine and NEXUS criteria in ruling out clinically important cervical spine injuries in trauma patients. Finally, we introduced the modified Canadian C-spine rule. METHODS: A prospective diagnostic accuracy study was conducted on trauma patients referred to four emergency departments of Iran in 2018. Emergency physicians evaluated the patients based on the Canadian C-spine rule and NEXUS criteria in two groups of low risk and high risk for clinically important cervical spine injury. Afterward, all patients underwent cervical imaging. In addition, modified Canadian C-spine rule was derived by removing dangerous mechanism and simple rear-end motor vehicle collision from the model. RESULTS: Data from 673 patients were included. The area under the curve of the NEXUS criteria, Canadian C-spine, and modified Canadian C-spine rule were 0.76 [95% confidence interval (CI) 0.71-0.81)], 0.78 (95% CI 0.74-0.83), and 0.79 (95% CI 0.74-0.83), respectively. The sensitivities of NEXUS criteria, Canadian C-spine, and modified Canadian C-spine rule were 93.4%, 100.0% and 100.0%, respectively. CONCLUSIONS: The modified Canadian C-spine rule has fewer variables than the original Canadian C-spine rule and is entirely based on physical examination, which seems easier to use in emergency departments.
PURPOSE: Although, Canadian C-spine rule and the National Emergency X-Radiography Utilization Study (NEXUS) criteria in ruling out clinically important cervical spine injuries have been validated using large prospective studies, no consensus exist as to which rule should be endorsed. Therefore, the aim of the present study was to compare the accuracy of the Canadian C-spine and NEXUS criteria in ruling out clinically important cervical spine injuries in traumapatients. Finally, we introduced the modified Canadian C-spine rule. METHODS: A prospective diagnostic accuracy study was conducted on traumapatients referred to four emergency departments of Iran in 2018. Emergency physicians evaluated the patients based on the Canadian C-spine rule and NEXUS criteria in two groups of low risk and high risk for clinically important cervical spine injury. Afterward, all patients underwent cervical imaging. In addition, modified Canadian C-spine rule was derived by removing dangerous mechanism and simple rear-end motor vehicle collision from the model. RESULTS: Data from 673 patients were included. The area under the curve of the NEXUS criteria, Canadian C-spine, and modified Canadian C-spine rule were 0.76 [95% confidence interval (CI) 0.71-0.81)], 0.78 (95% CI 0.74-0.83), and 0.79 (95% CI 0.74-0.83), respectively. The sensitivities of NEXUS criteria, Canadian C-spine, and modified Canadian C-spine rule were 93.4%, 100.0% and 100.0%, respectively. CONCLUSIONS: The modified Canadian C-spine rule has fewer variables than the original Canadian C-spine rule and is entirely based on physical examination, which seems easier to use in emergency departments.
Authors: John K Yue; Pavan S Upadhyayula; Andrew K Chan; Ethan A Winkler; John F Burke; William J Readdy; Sourabh Sharma; Hansen Deng; Sanjay S Dhall Journal: J Neurosurg Sci Date: 2015-11-24 Impact factor: 2.279
Authors: Iyore Ao James; Ahmad Moukalled; Elizabeth Yu; David B Tulman; Sergio D Bergese; Christian D Jones; Stanislaw Pa Stawicki; David C Evans Journal: J Emerg Trauma Shock Date: 2014-10