• Temple EM

Canadian C Spine vs NEXUS

“The Canadian C Spine rule versus the NEXUS low-risk criteria in patients with trauma”

N Engl J Med. 2003 Dec 25;349(26):2510-8.

Both CCR and NLC are used to guide the use of radiography in evaluating cervical spine injury in trauma patients. This study was to compare their clinical performance.

  1. Prospective cohort of 8283 trauma patients. Patients were evaluated with both rules, with radiography as the gold standard for diagnosis.

  2. 169 (2%) of patients were found to have clinically important c-spine injury

  3. 845 (10.2%) were labeled “indeterminate” and excluded from statistical analysis because physicians did not evaluate range of movement per the CCR algorithm.

  4. Sensitivity: CCR 99.4% vs NLC 90.7%

  5. Specificity: CCR 45.1% vs NLC 36.8%

Takeaway: CCR appears to be a better tool than NLC in ruling out clinically significant cervical spine injury, with a better sensitivity as well as reduced incidence of unnecessary imaging.

#decisionrules #Trauma

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