Saturday, May 26, 2012

NEXUS and Canadian C-spine rule: When to get films

Think about what you do in the ED? Do you recognize how following studies have impacted your practice?

National Emergency X-Radiography Utilization Study
Multicenter, prospective, observational study of patients with blunt trauma for whom cervical spine X-rays were obtained.

Get C-spine films if:

  • Patients with abnormal neurologic examination
  • Distracting or painful injury (like a femur fracture)
  • Depressed or altered mental status
  • Intoxication
  • Midline cervical tenderness should get an X-Ray

Canadian C-spine rule
A prospective cohort study in Canada evaluating patients with head or neck trrauma.

Radiography in high risk factors

  • Dangerous mechanism
  • Paresthesias

Assess range of motion in low-risk factors. If none of the following are present and the patient can actively rotate 45 degrees to left and right, then C-spine films may not be needed.

  • Simple rear-end MVC
  • Sitting position in the ED
  • Ambulatory at any time since injury
  • Delayed onset neck pain
  • Absence of midline C-spine tenderness

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