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

http://www.nejm.org/doi/full/10.1056/NEJM200007133430203


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

http://jama.jamanetwork.com/article.aspx?volume=286&issue=15&page=1841