![]() Hoffman JR, Schriger DL, Mower W, Luo JS, Zucker M. The NEXUS criteria are simple to use and have been effective in the intended population therefore, the NEXUS criteria are still a valuable clinical tool. Finally, the comparison study population was very different from that in the original NEXUS population, which included children and intoxicated patients. 1 In addition, about 10 percent of participants in the comparison study were not evaluated using the Canadian C-Spine Rule because physicians were afraid to move the necks of these patients. 2 The comparison study also used different wording for the NEXUS criteria than that used in its original study. The comparison study 5 was conducted in the same hospitals and with the same physicians as the original Canadian C-Spine Rule study. Although these findings seem to suggest that the Canadian C-Spine Rule is more accurate, there were several possible biases against the NEXUS criteria. 5 This study showed that, compared with the NEXUS criteria, the Canadian C-Spine Rule was more sensitive (99.4 versus 90.7 percent) and more specific (45 versus 37 percent) in its intended population. The Canadian C-Spine Rule 2 ( Figure 1 5 ) was prospectively validated in 8,283 Canadian patients it also was compared to the NEXUS criteria in a large clinical trial. The patient with the second missed injury did not have neck pain but had a fracture at the right lamina of C-6 that eventually required laminectomy and fusion. ![]() Of the latter two missed injuries, one was described in one report (but not in others) as an “extension teardrop” fracture the patient refused treatment and was asymptomatic at six weeks. The NEXUS criteria correctly identified 810 out of 818 patients (99.0 percent) with C-spine injury and 576 out of 578 patients (99.7 percent) with clinically significant injury. The study included a broad range of patients, the age range was one to 101 years, and intoxicated patients were included. 3 Patients who did not have C-spine radiography or who had the test for reasons other than trauma were excluded. health centers with blunt trauma who underwent C-spine radiography. 1 The largest of these prospective validation studies included 34,069 patients presenting to 21 U.S. The lack of definitions of instability and fusion acceptable to all the clinicians was likely a primary source of disagreement with both manual and computer-assisted assessments.The National Emergency X-Radiography Utilization Study (NEXUS) low-risk criteria for C-spine radiography in patients with blunt trauma ( Table 1 1 ) were developed and validated over a 10-year period. This study suggests that commonly used methods to assess flexion-extension X-rays of the cervical spine may not provide reliable clinical information about intervertebral motion abnormalities, and that validated, computer-assisted methods can dramatically improve agreement among clinicians. ![]() With computer-assisted methods, disagreements involved cases with severe degeneration or static misalignment where motion was within normal limits, or in fusion cases where there was between 1 and 1.5 degrees of motion at the fusion site. ![]() Computer-assisted analysis improved interobserver agreement (kappa=0.77). Agreement among clinicians with and without computer-assisted technology was assessed using kappa statistics.Īgreement was poor (kappa=0.17) with methods routinely used in clinical practice. Observers assessed the studies using the methods they routinely use, and then reassessed the studies, at least a month later, using validated computer-assisted methods. Seventy-five flexion-extension X-rays of the cervical spine, obtained from several clinical practices, were assessed by seven practicing physicians who routinely assess these X-rays. Quantify observer agreement on intervertebral motion abnormalities assessed with and without the use of computer-assisted technology.Īssess interobserver agreement among clinicians when they evaluate cervical flexion-extension X-rays using the methods they now use in clinical practice, and compare this to observer agreement when the same clinicians reassess the X-rays using computer-assisted technology. Flexion-extension X-rays are commonly used to identify abnormalities in intervertebral motion, despite little evidence for the reliability of the information that clinicians derive from these test. ![]()
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