Value of Canadian C-spine rule versus the NEXUS criteria in ruling out clinically important cervical spine injuries: der
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COMPUTED TOMOGRAPHY
Value of Canadian C‑spine rule versus the NEXUS criteria in ruling out clinically important cervical spine injuries: derivation of modified Canadian C‑spine rule Parisa Ghelichkhani1 · Kavous Shahsavarinia2 · Afshin Gharekhani3 · Ali Taghizadieh4 · Alireza Baratloo5,6 · Fattah Hama Rahim Fattah7 · Najmeh Abbasi8 · Mohammed I. M. Gubari9 · Gholamreza Faridaalee9 · Hossein Dinpanah10 · Mir Saeed Yekaninejad11 · Alireza Esmaeili12 · Michael E. Jones13 · Shaghayegh Askarian‑Amiri14 · Mahmoud Yousefifard14 · Mostafa Hosseini11,15 Received: 9 October 2019 / Accepted: 6 September 2020 © Italian Society of Medical Radiology 2020
Abstract Purpose Although, Canadian C-spine rule and the National Emergency X-Radiography Utilization Study (NEXUS) criteria in ruling out clinically important cervical spine injuries have been validated using large prospective studies, no consensus exist as to which rule should be endorsed. Therefore, the aim of the present study was to compare the accuracy of the Canadian C-spine and NEXUS criteria in ruling out clinically important cervical spine injuries in trauma patients. Finally, we introduced the modified Canadian C-spine rule. Methods A prospective diagnostic accuracy study was conducted on trauma patients referred to four emergency departments of Iran in 2018. Emergency physicians evaluated the patients based on the Canadian C-spine rule and NEXUS criteria in two groups of low risk and high risk for clinically important cervical spine injury. Afterward, all patients underwent cervical imaging. In addition, modified Canadian C-spine rule was derived by removing dangerous mechanism and simple rear-end motor vehicle collision from the model. Results Data from 673 patients were included. The area under the curve of the NEXUS criteria, Canadian C-spine, and modified Canadian C-spine rule were 0.76 [95% confidence interval (CI) 0.71–0.81)], 0.78 (95% CI 0.74–0.83), and 0.79 (95% CI 0.74–0.83), respectively. The sensitivities of NEXUS criteria, Canadian C-spine, and modified Canadian C-spine rule were 93.4%, 100.0% and 100.0%, respectively. Conclusions The modified Canadian C-spine rule has fewer variables than the original Canadian C-spine rule and is entirely based on physical examination, which seems easier to use in emergency departments. Keywords Cervical spine · Diagnostic imaging · Sensitivity and specificity · Decision supportive technique · Trauma
Introduction
Electronic supplementary material The online version of this article (https://doi.org/10.1007/s11547-020-01288-7) contains supplementary material, which is available to authorized users. * Mahmoud Yousefifard [email protected] * Mostafa Hosseini [email protected] Extended author information available on the last page of the article
Traumatic cervical spine injury is one of the most important and challenging issues in the management of patients in emergency departments [1]. These patients comprise a significant portion of long lasting injuries and severe disabilities [2]. Most physician
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