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Correlation of Ordered Cervical Spine X-rays in Emergency Department with NEXUS and Canadian C-Spine Rules; a Clinical Audit

Hamid Kariman, Mostafa Alavi Moghadam, Zhale Rajavi, Batsabe Masjoodi
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Abstract

Introduction: Evaluation of cervical spine injuries makes up a major part of trauma patient assessments. Based on the existing sources, more than 98% of the cervical spine X-rays show no positive findings. Therefore, the present clinical audit aimed to evaluate the correlation of ordered cervical spine X-rays in multiple trauma patients with NEXUS and Canadian c-spine clinical decision rules. Methods: The present clinical audit, evaluated the correlation of cervical spine imaging orders in multiple trauma patients presented to the emergency department, with NEXUS and Canadian c-spine rules. Initially, in a pilot study, the mentioned correlation was evaluated, and afterwards the results of this phase was analyzed. Since the correlation was low, an educational training was planned for all the physicians in charge. Finally, the calculated correlations for before and after training were compared using SPSS version 21. Results: Before and after training, cervical spine X-ray was ordered for 98 (62.82%) and 85 (54.48%) patients, respectively. Accuracy of cervical spine X-ray orders, based on the standard clinical decision rules, increased from 100 (64.1%) cases before training, to 143 (91.7%) cases after training (p < 0.001). Area under the receiver operating characteristic (ROC) curve regarding the correlation also raised from 52 (95% confidence interval (CI): 43 – 61) to 92 (95% CI: 87 – 97). Conclusion: Teaching NEXUS and Canadian c-spine clinical decision rules plays a significant role in improving the correlation of cervical spine X-ray orders in multiple trauma patients with the existing standards.

Keywords

Decision support techniques; radiography; spinal injuries; emergency service, hospital; neck injuries

References

McCaig LF, Burt CW. National hospital ambulatory medical care survey: 1999 emergency department summary: Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Health Statistics; 2001.

Stiell IG, Wells GA, Vandemheen KL, et al. The Canadian C-spine rule for radiography in alert and stable trauma patients. Jama. 2001;286(15):1841-8.

Vandemark R. Radiology of the cervical spine in trauma patients: practice pitfalls and recommendations for improving efficiency and communication. AJR American journal of roentgenology. 1990;155(3):465-72.

Roberge R. Facilitating cervical spine radiography in blunt trauma. Emergency medicine clinics of North America. 1991;9(4):733-42.

Brenner DJ, Hall EJ. Computed tomography—an increasing source of radiation exposure. New England Journal of Medicine. 2007;357(22):2277-84.

Hoffman JR, Mower WR, Wolfson AB, Todd KH, Zucker MI. Validity of a Set of Clinical Criteria to Rule Out Injury to the Cervical Spine in Patients with Blunt Trauma. New England Journal of Medicine. 2000;343(2):94-9.

ROBERGE RJ, WEARS RC, KELLY M, et al. Selective application of cervical spine radiography in alert victims of blunt trauma: a prospective study. Journal of Trauma and Acute Care Surgery. 1988;28(6):784-8.

McNamara RM, Heine E, Esposito B. Cervical spine injury and radiography in alert, high-risk patients. The Journal of emergency medicine. 1990;8(2):177-82.

Stiell I, Wells G, Vandemheen K, et al. Variation in emergency department use of cervical spine radiography for alert, stable trauma patients. Canadian Medical Association Journal. 1997;156(11):1537-44.

Stiell IG, Wells GA. Methodologic standards for the development of clinical decision rules in emergency medicine. Annals of emergency medicine. 1999;33(4):437-47.

Graham ID, Stiell IG, Laupacis A, O'Connor AM, Wells GA. Emergency physicians' attitudes toward and use of clinical decision rules for radiography. Academic Emergency Medicine. 1998;5(2):134-40.

Kerr D, Bradshaw L, Kelly A-M. Implementation of the Canadian C-spine rule reduces cervical spine x-ray rate for alert patients with potential neck injury. The Journal of emergency medicine. 2005;28(2):127-31.

Stiell IG, Clement CM, Grimshaw J, et al. Implementation of the Canadian C-Spine Rule: prospective 12 centre cluster randomised trial. Bmj. 2009;339:b4146.


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