C-spine rules and the elderly

The NEXUS criteria: do they stand the test of time?

European Journal of Emergency Medicine: February 2013 – Volume 20 – Issue 1 – p 58–60

The National Emergency X-ray Utilisation Study (NEXUS) criteria and the Canadian cervical spine rules are validated clinical decision-making tools used to facilitate selective cervical spine (C-spine) radiography. The NEXUS criteria are frequently used, as the Canadian cervical spine rules have been noted to be difficult to learn, remember and implement. While the rules are often used to decide whether radiography is required, the questions asked are similar to the should we immobilise questions asked by pre-hospital care providers.

© Gary Wilson/ Pre-hospital Research Forum

© Gary Wilson/ Pre-hospital Research Forum

In this article the authors present a series of significant C-spine injury in three elderly patients who would not have warranted C-spine imaging using the NEXUS criteria. Each patient was mobile and fully orientated after the injury. There was no midline tenderness, neurological deficit, distracting injury or alcohol/drug involvement. Plain film imaging was initially performed as each patient had a reduced range of movement. Significant odontoid peg injury was confirmed on subsequent computed tomography/MRI imaging for all patients.

Despite previous validation studies of the NEXUS criteria in the elderly population, the authors urge caution in using the NEXUS criteria alone in determining radiography of the C-spine in the elderly. Similarly, the pathophysiological changes associated of ageing, mechanism of injury, history and patient presentation should be incorporated into the elderly patient assessment before the immobilisation decision is made rather than simply following C-spine immobilisation rules.

http://journals.lww.com/euro-emergencymed/Abstract/2013/02000/The_NEXUS_criteria___do_they_stand_the_test_of.12.aspx.

For more information on the NEXUS and Canadian cervical spine rules, the following article, while ten years old, provides a good comparison between the two methods:

The Canadian C-Spine Rule versus the NEXUS Low-Risk Criteria in Patients with Trauma

N Engl J Med 2003; 349:2510-2518December 25, 2003

Full text article at: http://www.nejm.org/doi/full/10.1056/NEJMoa031375#t=articleTop

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