Article type
Year
Abstract
Background:
Cervical spine trauma can lead to clinically important injuries such as fractures, dislocations and ligament instability. It represents approximately 3.5% of trauma occurring in emergency departments around the world. Cervical injuries can have severe consequences such as spinal cord injury and even death. For this reason, the diagnosis must be made early. The diagnosis is usually done by imaging exams such as radiography, nuclear magnetic resonance and computed tomography. The latter is the most used on initial examination in polytrauma patients or those with a high suspicion of injury. Even with a low prevalence of injuries, these tests are performed between 60% to 90% of stable patients in alert state (Glasgow = 15). In addition, they generate high costs and sometimes unnecessary exposure to radiation. Clinical decision rules can help clinicians to rule out serious injuries without imaging. The “Canadian cervical spine rule” (CCR) and “The National Emergence X-Radiography utilization study” (NEXUS) are the most commonly used clinical decision rules after blunt cervical trauma.
Objectives:
The aim of this systematic review was to describe and compare the diagnostic accuracy between CCR and NEXUS in patients with suspected cervical injury followed by sudden trauma.
Methods:
We searched on MEDLINE, EMBASE, CINAHL and LILACS. The criteria for considering studies in this review were: being a prospective cohort or cross-sectional study; have a population of adults with suspected cervical injury after sudden trauma; have an analysis of diagnostic accuracy with CCR, NEXUS or both rules; the rules be compared with a standard exam of reference. We used the modified version of the QUADAS-2 tool to analyse the methodological quality of the studies. The data from each study was used to generate the contingency table and the true positives, true negatives, false positives and false negatives, and to calculate the sensitivity, specificity and 95% confidence interval of each test. To estimate the summary of sensitivity and specificity, we performed a meta-analysis using the bivariate logistics model.
Results:
We found 1090 articles, of which 24 were included in this review (Figure 1). Most included studies presented moderate methodological quality. This review is still ongoing and at the moment we have analysed data from 15 studies. The sensitivity of the CCR ranged from 0.90 to 1.00 compared to 0.83 to 1.00 by NEXUS. The specificity of the CCR was between 0.01 to 0.77 compared to 0.02 to 0.46 by NEXUS.
Conclusions:
The preliminar results of this review showed that the diagnostic accuracy of CCR appears to be greater compared to NEXUS to assess possible severe cervical injuries in patients following blunt trauma.
Patient or healthcare consumer involvement:
Cervical spine trauma can lead to clinically important injuries such as fractures, dislocations and ligament instability. It represents approximately 3.5% of trauma occurring in emergency departments around the world. Cervical injuries can have severe consequences such as spinal cord injury and even death. For this reason, the diagnosis must be made early. The diagnosis is usually done by imaging exams such as radiography, nuclear magnetic resonance and computed tomography. The latter is the most used on initial examination in polytrauma patients or those with a high suspicion of injury. Even with a low prevalence of injuries, these tests are performed between 60% to 90% of stable patients in alert state (Glasgow = 15). In addition, they generate high costs and sometimes unnecessary exposure to radiation. Clinical decision rules can help clinicians to rule out serious injuries without imaging. The “Canadian cervical spine rule” (CCR) and “The National Emergence X-Radiography utilization study” (NEXUS) are the most commonly used clinical decision rules after blunt cervical trauma.
Objectives:
The aim of this systematic review was to describe and compare the diagnostic accuracy between CCR and NEXUS in patients with suspected cervical injury followed by sudden trauma.
Methods:
We searched on MEDLINE, EMBASE, CINAHL and LILACS. The criteria for considering studies in this review were: being a prospective cohort or cross-sectional study; have a population of adults with suspected cervical injury after sudden trauma; have an analysis of diagnostic accuracy with CCR, NEXUS or both rules; the rules be compared with a standard exam of reference. We used the modified version of the QUADAS-2 tool to analyse the methodological quality of the studies. The data from each study was used to generate the contingency table and the true positives, true negatives, false positives and false negatives, and to calculate the sensitivity, specificity and 95% confidence interval of each test. To estimate the summary of sensitivity and specificity, we performed a meta-analysis using the bivariate logistics model.
Results:
We found 1090 articles, of which 24 were included in this review (Figure 1). Most included studies presented moderate methodological quality. This review is still ongoing and at the moment we have analysed data from 15 studies. The sensitivity of the CCR ranged from 0.90 to 1.00 compared to 0.83 to 1.00 by NEXUS. The specificity of the CCR was between 0.01 to 0.77 compared to 0.02 to 0.46 by NEXUS.
Conclusions:
The preliminar results of this review showed that the diagnostic accuracy of CCR appears to be greater compared to NEXUS to assess possible severe cervical injuries in patients following blunt trauma.
Patient or healthcare consumer involvement: