This week on Briefs I wanted to present – with limited comment – a synopsis of the NEXUS and Canadian C-Spine rules. In general, the most common reason we end up getting cervical spine films in the Peds ED is for midline C-Spine pain. I trust you’d all agree that it is important to understand why we do this, and can enumerate other reasons to order films for suspected C spine injury. The title of each links to the seminal articles.
NEXUS (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:
- Abnormal neurologic examination
- Distracting or painful injury (like a femur fracture)
- Depressed or altered mental status
- Intoxication
- Midline cervical tenderness
Canadian C-spine rule
A prospective cohort study in Canada evaluating patients with head or neck trauma.
Radiography is definitely recommended in high risk factors
- Dangerous mechanism
- Paresthesias
If any of the following low risk factors 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
I think that the Canadian C-Spine rules say that if ANY of the low risk factors ARE present and they can rotate 45 degree, no XR.
Natalie you are right – thanks for catching my typo! http://img.mdcalc.com/clinical/canadian-cspine.png