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Author Dahlquist, Robert T. ♦ Fischer, Peter E. ♦ Desai, Harsh ♦ Rogers, Amelia ♦ Christmas, A. Britton ♦ Gibbs, Michael A. ♦ Sing, Ronald F.
Source World Health Organization (WHO)-Global Index Medicus
Content type Text
Publisher Elsevier
File Format HTM / HTML
Language English
Difficulty Level Medium
Subject Domain (in DDC) Social sciences ♦ Social problems & services; associations ♦ Social welfare problems & services ♦ Natural sciences & mathematics ♦ Life sciences; biology ♦ Natural history of organisms ♦ Technology ♦ Medicine & health ♦ Human anatomy, cytology, histology ♦ Diseases ♦ Manufacture for specific uses ♦ Precision instruments & other devices
Subject Domain (in MeSH) Musculoskeletal System ♦ Anatomy ♦ Eukaryota ♦ Organisms ♦ Wounds and Injuries ♦ Diseases ♦ Investigative Techniques ♦ Analytical, Diagnostic and Therapeutic Techniques and Equipment ♦ Persons ♦ Persons ♦ Health Care Facilities, Manpower, and Services ♦ Health Care
Subject Keyword Discipline Emergency ♦ Discipline Medicine ♦ Cervical Vertebrae ♦ Injuries ♦ Emergency Service, Hospital ♦ Femoral Fractures ♦ Complications ♦ Spinal Injuries ♦ Diagnosis ♦ Wounds, Nonpenetrating ♦ Adolescent ♦ Adult ♦ Aged ♦ Aged, 80 And Over ♦ Child ♦ Child, Preschool ♦ Female ♦ Humans ♦ Infant ♦ Male ♦ Middle Aged ♦ Retrospective Studies ♦ Sensitivity And Specificity ♦ Young Adult ♦ Journal Article
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.
Description Country affiliation: New Caledonia
Author Affiliation: Dahlquist RT ( Carolinas Medical Center, Carolinas HealthCare System, Charlotte, NC.); Fischer PE ( Carolinas Medical Center, Carolinas HealthCare System, Charlotte, NC.); Desai H ( University of Maryland School of Medicine, Baltimore, MD.); Rogers A ( University of Maryland School of Medicine, Baltimore, MD.); Christmas AB ( Carolinas Medical Center, Carolinas HealthCare System, Charlotte, NC.); Gibbs MA ( Carolinas Medical Center, Carolinas HealthCare System, Charlotte, NC.); Sing RF ( Carolinas Medical Center, Carolinas HealthCare System, Charlotte, NC. Electronic address: ron.sing@carolinashealthcare.org.)
ISSN 07356757
Educational Role Student ♦ Teacher
Age Range above 22 year
Educational Use Reading ♦ Research ♦ Self Learning
Interactivity Type Expositive
Education Level UG and PG
Learning Resource Type Article
Publisher Date 2015-12-01
Publisher Place United States
e-ISSN 15328171
Journal The American Journal of Emergency Medicine
Volume Number 33
Issue Number 12


Source: WHO-Global Index Medicus