Femur fractures should not be considered distracting injuries for cervical spine assessment.

Abstract

INTRODUCTION:

The National Emergency X-Radiography Utilization Study (NEXUS) clinical decision rule is extremely sensitive for clearance of cervical spine (C-spine) injury in blunt trauma patients with distracting injuries.

OBJECTIVES:

We sought to determine whether the NEXUS criteria would maintain sensitivity for blunt trauma patients when femur fractures were not considered a distracting injury and an absolute indication for diagnostic imaging.

METHODS:

We retrospectively analyzed blunt trauma patients with at least 1 femur fracture who presented to our emergency department as trauma activations from 2009 to 2011 and underwent C-spine injury evaluation. Presence of C-spine injury requiring surgical intervention was evaluated.

RESULTS:

Of 566 trauma patients included, 77 (13.6%) were younger than 18 years. Cervical spine injury was diagnosed in 53 (9.4%) of 566. A total of 241 patients (42.6%) had positive NEXUS findings in addition to distracting injury; 51 (21.2%) of these had C-spine injuries. Of 325 patients (57.4%) with femur fractures who were otherwise NEXUS negative, only 2 (0.6%) had C-spine injuries (95% confidence interval [CI], 0.2%-2.2%); both were stable and required no operative intervention. Use of NEXUS criteria, excluding femur fracture as an indication for imaging, detected all significant injuries with a sensitivity for any C-spine injury of 96.2% (95% CI, 85.9%-99.3%) and negative predictive value of 99.4% (95% CI, 97.6%-99.9%).

CONCLUSIONS:

In our patient population, all significant C-spine injuries were identified by NEXUS criteria without considering the femur fracture a distracting injury and indication for computed tomographic imaging. Reconsidering femur fracture in this context may decrease radiation exposure and health care expenditure with little risk of missed diagnoses.

• Authors: Robert T Dahlquist, Peter E Fischer, Harsh Desai, Amelia Rogers, A Britton Christmas, Michael A Gibbs, Ronald F Sing
• Journal: The American journal of emergency medicine (Am J Emerg Med) Vol. 33 Issue 12 Pg. 1750-4 (Dec 2015) ISSN: 1532-8171 [Electronic] United States
• PMID: 26346048 (Publication Type: Journal Article)
• Copyright: Copyright © 2015 Elsevier Inc. All rights reserved.

Topics

• Adolescent
• Adult
• Aged
• Aged, 80 and over
• Cervical Vertebrae (injuries)
• Child
• Child, Preschool
• Emergency Service, Hospital
• Female
• Femoral Fractures (complications, diagnosis)
• Humans
• Infant
• Male
• Middle Aged
• Retrospective Studies
• Sensitivity and Specificity
• Spinal Injuries (complications, diagnosis)
• Wounds, Nonpenetrating (complications, diagnosis)
• Young Adult