Falls and Implementation of NEXUS in the Elderly (The FINE Study)

Cervical spine fracture in geriatric blunt trauma: are the NEXUS criteria sensitive enough?

“…16,24 This predominance of ground-level falls may have contributed to the similar sensitivity reported between the present work (89.5%) and a previous investigation exclusively examining geriatric ground-level falls, which reported an 88.9% sensitivity in detecting clinically significant injury. 15 An investigation of high-energy mechanisms requiring trauma team activation reported even lower sensitivity in the geriatric population, which was significantly reduced compared to the already inadequate sensitivity demonstrated in the younger adults (65.9% vs. 84.2% P<0.0001). 14 These results support prior findings indicating insufficient NEXUS sensitivity in severe blunt trauma, 22 while also demonstrating that NEXUS has significantly worse performance in the geriatric cohort.…”

“…The sensitivity of the criteria, however, requires re-examination as prospective and retrospective studies have questioned the reliability of NEXUS, 22 particularly in the geriatric population. [14][15][16] While no significant CF was undetected after radiographic evaluation, 28.6% of patients with significant CF presented without subjective pain or TTP. The present rate of asymptomatic CF is slightly higher than a previous study of adults (≥55 years) that reported 21% of patients denying pain or TTP, which was extrapolated to 18.3% among patients sustaining injury requiring treatment.…”

“…[1][2][3] The paradigm shift to computed tomography (CT) as the standard imaging modality warrants reassessment of the NEXUS criteria secondary to the enhanced cervical spine injury detection provided by CT. [4][5][6][7][8][9][10][11][12][13] Recent external validations have raised concern regarding the use of the NEXUS criteria in geriatric trauma, though the existing literature offers little consensus with NEXUS sensitivity ranging from 65.9% to 94.8%. [14][15][16] One considerable confound in this literature, however, is the frequent exclusion of non-geriatric patients. 15,16 Without the appropriate population of younger counterparts, it is difficult to ascertain whether the findings in the geriatric population are truly age-specific.…”

“…[14][15][16] One considerable confound in this literature, however, is the frequent exclusion of non-geriatric patients. 15,16 Without the appropriate population of younger counterparts, it is difficult to ascertain whether the findings in the geriatric population are truly age-specific. The existing literature is also limited by an inconsistent consideration for whether missed injuries were clinically significant.…”

“…14,16 Additionally, some investigations restricted the scope to low-or high-energy mechanisms of injury. 14,15 To enhance the current understanding of the relationship between the NEXUS criteria and patient age, the present study aimed to compare the NEXUS criteria's sensitivity in identifying individuals with significant cervical spine fracture (CF) between non-geriatric (age <65 years) and geriatric (age ≥65 years) patients sustaining injury from any blunt trauma mechanism. It was hypothesized that NEXUS sensitivity would be significantly reduced in the geriatric population.…”