Screening Cervical Spine CT in a Level I Trauma Center: Overutilization?

Griffith, Brent; Bolton, Carrie; Goyal, Nikhil; Brown, Manuel L.; Jain, Rajan

doi:10.2214/ajr.10.5731

Cited by 42 publications

(27 citation statements)

References 12 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…This may explain some of the differences noted in the reported rate of overuse in the retrospective study (23.9%) 11 and the current prospective study (16.1%). Finally, direct comparison of the results of this prospective study with the results of the prior retrospective study is difficult.…”

Section: Discussioncontrasting

confidence: 70%

“…While 4 patients with cervical spine injury met NEXUS criteria for foregoing imaging in the retrospective study, 11 proper application of both the NEXUS and abbreviated CCR criteria allowed detection of all patients with cervical spine injury in the current study. Moreover, while this study was not designed to test the sensitivity of either criteria, both the NEXUS and CCR had sensitivities of 100% for detecting cervical spine injury in the imaged population.…”

Section: Discussionmentioning

confidence: 96%

“…Subsequent studies have questioned the sensitivity of these criteria, particularly the NEXUS criteria. 2,11,12 A study by Duane et al 13 in 2007 suggested that a clinical examination cannot reliably diagnose or exclude cervical spine fracture in patients with blunt trauma. Despite this suggestion, both NEXUS and CCR are still widely used, and the American College of Radiology accepts both criteria in their appropriateness guidelines as a means of screening patients before imaging the cervical spine.…”

Section: Discussionmentioning

confidence: 99%

“…The retrospective study performed at our institution found that strict application of NEXUS criteria before cervical spine imaging would have resulted in a 23.9% reduction in the number of cervical spine CT scans with negative findings in patients presenting with blunt trauma. 11 However, because that study was based on retrospective chart review, the data were limited to information recorded by medical personnel at the time of the patient's presentation. This limitation resulted in uncertainty about the accuracy of the calculated rate of overuse.…”

Section: Discussionmentioning

confidence: 99%

“…A retrospective study performed at our institution found that 23.9% of patients undergoing CT of the cervical spine following blunt trauma satisfied the 5 NEXUS criteria and should have avoided cervical spine imaging. 11 However, given the inherent limitations of a retrospective review, including possible errors or omissions in the medical records, a collaborative prospective study between the departments of radiology and emergency medicine was undertaken. The purpose of this study was to prospectively determine the number of potentially avoidable cervical spine CT studies on the basis of proper application of established clinical guidelines.…”

mentioning

confidence: 99%

See 4 more Smart Citations

Screening Cervical Spine CT in the Emergency Department, Phase 2: A Prospective Assessment of Use

Griffith

Kelly²,

Vallee³

et al. 2012

AJNR Am J Neuroradiol

View full text Add to dashboard Cite

BACKGROUND AND PURPOSE:The National Emergency X-Radiography Utilization Study Low-Risk Criteria were established to identify patients with a low probability of cervical spine injury in whom imaging of the cervical spine was unnecessary. The purpose of this study was to ascertain the number of unnecessary cervical spine CT studies on the basis of proper application of established clinical guidelines and, secondarily, to determine indications for ordering studies in the absence of guideline criteria.

show abstract

Section: Discussioncontrasting

confidence: 70%

Section: Discussionmentioning

confidence: 96%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

See 3 more Smart Citations

Screening Cervical Spine CT in the Emergency Department, Phase 2: A Prospective Assessment of Use

Griffith

Kelly²,

Vallee³

et al. 2012

AJNR Am J Neuroradiol

View full text Add to dashboard Cite

show abstract

Cost-effectiveness of Magnetic Resonance Imaging in Cervical Clearance of Obtunded Blunt Trauma After a Normal Computed Tomographic Finding

Geng

Kalra

et al. 2018

JAMA Surg

View full text Add to dashboard Cite

Magnetic resonance imaging had a lower health benefit and a higher cost compared with no follow-up after a normal CT finding in patients with obtunded blunt trauma to the cervical spine, a finding that does not support the use of MRI in this group of patients. The conclusion is robust in sensitivity analyses varying key variables in the model. More literature on these key variables is needed before MRI can be considered to be beneficial in the evaluation of obtunded blunt trauma.

show abstract

Triage tools for detecting cervical spine injury in pediatric trauma patients

Slaar

Fockens

Wang

et al. 2017

Cochrane Database of Systematic Reviews

View full text Add to dashboard Cite

There are currently few studies assessing the diagnostic test accuracy of the NEXUS criteria and CCR in children. At the moment, there is not enough evidence to determine the accuracy of the Canadian C-spine Rule to detect CSI in pediatric trauma patients following blunt trauma. The confidence interval of the sensitivity of the NEXUS criteria between the individual studies showed a wide range, with a lower limit varying from 0.18 to 0.91 with a total of four false negative test results, meaning that if physicians use the NEXUS criteria in children, there is a chance of missing CSI. Since missing CSI could have severe consequences with the risk of significant morbidity, we consider that the NEXUS criteria are at best a guide to clinical assessment, with current evidence not supporting strict or protocolized adoption of the tool into pediatric trauma care. Moreover, we have to keep in mind that the sensitivity differs among several studies, and individual confidence intervals of these studies show a wide range. Our main conclusion is therefore that additional well-designed studies with large sample sizes are required to better evaluate the accuracy of the NEXUS criteria or the Canadian C-spine Rule, or both, in order to determine whether they are appropriate triage tools for the clearance of the cervical spine in children following blunt trauma.

show abstract

Screening Cervical Spine CT in a Level I Trauma Center: Overutilization?

Abstract: The strict application of the NEXUS low-risk criteria could potentially reduce the number of screening cervical spine CT examinations in the setting of trauma in more than 20% of cases, thereby avoiding a significant amount of unnecessary radiation and significant cost.

Cited by 42 publications

References 12 publications

Screening Cervical Spine CT in the Emergency Department, Phase 2: A Prospective Assessment of Use

Screening Cervical Spine CT in the Emergency Department, Phase 2: A Prospective Assessment of Use

Cost-effectiveness of Magnetic Resonance Imaging in Cervical Clearance of Obtunded Blunt Trauma After a Normal Computed Tomographic Finding

Triage tools for detecting cervical spine injury in pediatric trauma patients

Contact Info

Product

Resources

About