National emergency X-radiography utilization study guidelines versus Canadian C-Spine guidelines on trauma patients, a prospective analytical study

Ala, Alireza; Vahdati, Samad Shams; Ghaffarzad, Amir; Mousavi, Haleh; Mirza-Aghazadeh-Attari, Mohammad

doi:10.1371/journal.pone.0206283

Cited by 11 publications

(6 citation statements)

References 25 publications

(26 reference statements)

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“…This comparison between CCR and NEXUS has already been made by Stiell et al, revealing values of 55.9% and 66.6%, and by Ala et al in 2017, revealing values of 57.5% and 47.5%, respectively. 12,15 These researchers used the same methodology in their studies, the first having a significantly larger sample and an outcome that differs from the one found here, which is closer to that of the second study. Such concordance may be related to the sample size and the epidemiological characteristics of the trauma mechanism, which are similar to those of this study.…”

Section: Discussionmentioning

confidence: 59%

Algorithms for Clinical Assessment of the Cervical Spine in Patients With Severe Trauma: A Mixed-Method Analyzis

et al. 2021

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Objective: Cervical trauma is an important cause of morbidity and mortality, affecting 2% of patients admitted to emergency units. Therefore, this study aims to compare the use of two clinical cervical spine evaluation algorithms, the Canadian C-Spine Rule (CCR) and the National Emergency X-radiography Utilization Study (NEXUS). Methods: A descriptive study of the use of the two algorithms by medical residents in the initial assessment of severely traumatized patients admitted to the regional emergency unit was conducted. The evaluation of the indication for imaging tests and the positive predictive value of the algorithms were the parameters analyzed. Finally, the residents answered a questionnaire evaluating the applicability, degree of confidence and advantages of both flowcharts. Results: There was no significant difference between the number of indications for imaging or their predictive values. In the analysis of the questionnaires, the CCR proved to be more reliable and the NEXUS more applicable, and the positive and negative points of applying each of them were highlighted. Conclusion: It is concluded that the two methods are similar in detecting injuries and optimizing the use of imaging exams, being equally indicated to evaluate cervical trauma. However, the technical specifics of each must be taken into account when deciding which to use. Level of evidence IV; Descriptive Study.

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Section: Discussionmentioning

confidence: 59%

Algorithms for Clinical Assessment of the Cervical Spine in Patients With Severe Trauma: A Mixed-Method Analyzis

et al. 2021

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“…One of the key attributes of using the NEXUS criteria is eliminating the need for lateral neck radiographs in trauma patients [ 27 ]. However, the poor performance of NEXUS compared to other decision rules such as the New Orleans Criteria (NOC) and the Canadian CT Head Rule (CCHR) in assessing the need for radiology in pediatric head trauma also demonstrates that there is reason to doubt its wider use [ 28 ].…”

Section: Reviewmentioning

confidence: 99%

Implementation of National Emergency X-Radiography Utilization Study (NEXUS) Criteria in Pediatrics: A Systematic Review

Ekhator¹,

Nwankwo²,

Nicol³

2022

Cureus

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Since its introduction in 1992, the National Emergency X-Radiography Utilization Study (NEXUS) criteria have been used in trauma to decide whether a patient requires radiographic imaging. The tool is important in reducing radiation exposure. However, applying the NEXUS criteria for cervical spine imaging in pediatric patients is poorly supported compared to their use in adults. The objective of this review was to examine the effectiveness of using the NEXUS criteria in the diagnostic management of pediatric cervical spine injuries (CSI). The following databases were searched for studies focused on applying the NEXUS criteria for CSI in pediatric patients: Cochrane, PubMed, Google Scholar, EMBASE, ELSEVIER, and ScienceDirect. Additional studies were found through reference lists of primary sources and previous systematic and meta-analyses. The search focused on randomized controlled trials (RCTs), cohort studies, retrospective studies, prospective studies, and other uncontrolled trials published from 2000 to 2022. There were seven included studies with a total of 4502 pediatric patients. Five of the included studies were retrospective studies, while the remaining were prospective and case studies. Our results show that the sensitivity ranged from 43% to 100%, while the specificity ranged from 12.93% to 96%. The sensitivity increased with age, with those under the age of two or under the age of eight reporting poorer outcomes than the older pediatric patients. One study also shows that the proportion of patients undergoing cervical spine CT increased from 18% to 61% in the initial period before the implementation of clearance guidelines. The implementation of guidelines led to a 23% decrease in CT scans clearable by NEXUS criteria after 12 months. One of the studies reported that NEXUS criteria were a cost-effective option when used along with X-rays and CT. Overall, the studies do not strongly support the application of the NEXUS criteria to image pediatric patients for CSI. In conclusion, there is weak support in the literature for applying the NEXUS criteria in determining the need for cervical spine imaging in pediatric trauma patients. The practice and research implications of the findings are also discussed.

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“…If abuse is suspected, information and an opportunity to disclose abuse should be provided in a trauma-informed way if possible. Importantly, for a TBI to occur, loss of consciousness is not necessary and intracranial findings are unlikely to be present if the TBI is “mild.” Clinicians may use Canadian CT Head Rule 52 or National Emergency X-Radiography Study II Clinical Guidelines 53 to ascertain the need of neuroimaging in mTBI patients. 54 , 55 As the severity of abuse has risen during the pandemic, the possibility of survivors presenting with moderate to severe TBI is highly likely.…”

Section: Health and Policy Actions For Ipv-related Abis Likely Fueled By The Mitigation Strategies Of Covid-19mentioning

confidence: 99%

COVID-19-induced surge in the severity of gender-based violence might increase the risk for acquired brain injuries

et al. 2021

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While initial reports have emphasized a global rise in the frequency of intimate partner violence following COVID-19, emerging data are now showing a concerning surge in the severity of COVID-19-induced physical intimate partner violence. One of the most dangerous, frequent, yet hidden consequences of severe physical intimate partner violence is acquired brain injury, including repetitive mild traumatic brain injury and hypoxic brain injury. Although the increase in high-risk physical abuse during COVID-19 is gaining recognition, what still remains absent is the urgent discussion on intimate partner violence–related acquired brain injury during these times. The potential analogous surge in intimate partner violence–related acquired brain injury may have implications for both healthcare providers and healthcare actions/policies as repeated brain injuries have been associated with residual functional deficits and chronic disability. In addition, even in the pre-pandemic times, intimate partner violence–related acquired brain injury is likely unrecognized and/or misclassified due to overlap in symptoms with other comorbid disorders. This review aimed to raise awareness about intimate partner violence–related acquired brain injury within the context of COVID-19. Health actions and policies that should be considered as part of the pandemic response to minimize adverse outcomes associated with intimate partner violence–related acquired brain injury have also been discussed.

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National emergency X-radiography utilization study guidelines versus Canadian C-Spine guidelines on trauma patients, a prospective analytical study

Cited by 11 publications

References 25 publications

Algorithms for Clinical Assessment of the Cervical Spine in Patients With Severe Trauma: A Mixed-Method Analyzis

Algorithms for Clinical Assessment of the Cervical Spine in Patients With Severe Trauma: A Mixed-Method Analyzis

Implementation of National Emergency X-Radiography Utilization Study (NEXUS) Criteria in Pediatrics: A Systematic Review

COVID-19-induced surge in the severity of gender-based violence might increase the risk for acquired brain injuries

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