Selective Cervical Spine Radiography in Blunt Trauma: Methodology of the National Emergency X-Radiography Utilization Study (NEXUS)☆,☆☆,★,★★
Section snippets
INTRODUCTION
Unrecognized cervical spine injury can produce catastrophic neurologic disability. Fear of failing to diagnose such injuries has led to the use of radiographic spine imaging in virtually all cases of multiple blunt trauma.1, 2 This practice exposes large numbers of patients to x-ray imaging, at considerable expense, while detecting injuries in a small minority.1, 2, 3, 4, 5, 6, 7 It is estimated that each year in the United States approximately 800,000 people undergo cervical spine radiography,
MATERIALS AND METHODS
NEXUS is a multicenter, prospective, observational study of ED patients with blunt trauma for whom cervical spine imaging is ordered. Participating centers represent a wide variety of facilities, including university hospitals, community teaching hospitals, and community hospitals without teaching programs; public hospitals and private hospitals; and hospitals with all levels of trauma categorization. In this prospective study, the presence or absence of the 4 low-risk criteria will be
DISCUSSION
Sporadic case reports have described rare patients with occult or even asymptomatic cervical spine injuries after blunt trauma.3, 4, 5, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27 Careful review of these cases indicates that most of them involved patients who were inadequately evaluated or who actually met at least 1 of the low-risk criteria considered in the NEXUS study. Nevertheless, fear of missing cervical spine injuries, with their potential to produce severe neurologic disability, has led to
Acknowledgements
The following centers and investigators collaborated in this study.
Principal Investigator: W Mower.
Coinvestigator: J Hoffman. Steering Committee: J Hoffman, W Mower, K Todd, A Wolfson, M Zucker.
Site Investigators: Antelope Valley Medical Center (Los Angeles): M Brown, R Sisson; Bellevue Hospital (New York): W Goldberg, R Siegmann; Cedars-Sinai Medical Center (Los Angeles): J Geiderman, B Pressman; Crawford Long Hospital (Atlanta): S Pitts, W Davis; Egleston Children’s Hospital (Atlanta): H
References (41)
“Asymptomatic” cervical spine injuries: A myth?
Am J Emerg Med
(1985)- et al.
“Asymptomatic” cervical spine injuries: A myth? [reply]
Am J Emerg Med
(1985) - et al.
Subacute cervical spine instability
Surg Neurol
(1986) - et al.
Delayed presentation of unstable cervical spine injury with minimal symptoms
J Emerg Med
(1991) - et al.
Low-risk criteria for cervical spine radiography in blunt trauma: A prospective study
Ann Emerg Med
(1992) - et al.
Cervical injury in head trauma
J Emerg Med
(1988) - et al.
Post-traumatic neck pain: A prospective and follow-up study
Ann Emerg Med
(1988) - et al.
Evaluation of neck discomfort, neck tenderness, and neurologic deficits as indicators for radiography in blunt trauma victims
J Emerg Med
(1992) - et al.
Occult cervical spine fracture in an ambulatory patient
Ann Emerg Med
(1982) - et al.
Clinical presentation of patients with acute cervical spine injury
Ann Emerg Med
(1984)
Unstable occult cervical-spine fracture
Ann Emerg Med
Evaluation of the cervical spine: Unresolved issues
Ann Emerg Med
Prospective analysis of acute cervical spine injury: A methodology to predict injury
Ann Emerg Med
Cervical radiographic evaluation of alert patients following blunt trauma
Ann Emerg Med
High-yield roentgenographic criteria for cervical spine injuries
Ann Emerg Med
Rational ordering of cervical spine radiographs following trauma
Ann Emerg Med
Inter-rater reliability of cervical spine injury criteria in blunt trauma victims
Ann Emerg Med
Cervical subluxation: A deceptive soft tissue injury
J R Soc Med
Hidden flexion injury of the cervical spine
J Bone Joint Surg Br
Is the cervical spine clear? Undetected cervical fractures diagnosed only at autopsy
Ann Emerg Med
Cited by (293)
Blunt Head Injury in the Elderly: Analysis of the NEXUS II Injury Cohort
2024, Annals of Emergency MedicinePrehospital Trauma Care
2024, Surgical Clinics of North AmericaMedical Malpractice and Diagnostic Radiology: Challenges and Opportunities
2024, Academic RadiologyCan you see with CT? Is cervical spine computed tomographic imaging sufficient in pediatric trauma?
2023, American Journal of SurgeryCervical spine injuries in adults ≥ 65 years after low-level falls – A systematic review and meta-analysis
2023, American Journal of Emergency Medicine
- ☆
From The UCLA Emergency Medicine Center and Department of Medicine, UCLA School of Medicine, Los Angeles, CA, the Department of Emergency Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, and the Division of Emergency Medicine, Department of Surgery, Emory University School of Medicine, Atlanta, GA.
- ☆☆
This project was supported by grant number R01 HS08239 from the Agency for Health Care Policy and Research.
- ★
Reprint no. 47/1/93129
- ★★
Address for reprints:William R Mower, MD, PhD, 924 Westwood Boulevard, Suite 300, Los Angeles, CA 90024, 310-794-0582, Fax 310-794-9747, E-mail [email protected]