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.
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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)
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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
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