Canadian C-spine rule more accurate in diagnosing important cervical spine injuries than other rules

October 9, 2012

To screen for cervical spine injuries such as fractures in the emergency department, the Canadian C-spine rule appears to be more accurate compared with NEXUS, another commonly used rule, according to a study in CMAJ (Canadian Medical Association Journal). NEXUS stands for the National Emergency X-Radiography Utilization Study.

"In the only direct comparison, the Canadian C-spine rule appeared to have better diagnostic accuracy, and it should be used over NEXUS to assess the need for imaging," writes Dr. Chris Maher, Director, Musculoskeletal Division, The George Institute for Global Health, The University of Sydney, Sydney, Australia, with coauthors.

Both rules, which were developed independently using large patient samples, are recommended in many international guidelines to help exclude important cervical spine injuries. However, there is no consensus as to which rule is preferable. Screening tools such as these are useful because they can reduce the need for unnecessary diagnostic imaging, which can expose patients to radiation, and is also costly.

Researchers from Australia and The Netherlands looked at 15 research studies evaluating the use of either or both rule in diagnosing cervical spine injuries. However, only one study directly compared the two rules; all 14 other studies included in the analysis assessed accuracy of each rule separately. The Canadian C-spine rule appeared to have better and a lower rate of false negatives compared with NEXUS. A negative test helps exclude an important spinal injury and thus the need for .

However, both rules are effective in excluding cervical spine injuries while ensuring patient safety as this and previous studies show.

"Despite these findings, there is a more liberal use of imaging in current clinical practice, which may reflect patient preference, physicians' fear of litigation or missing a fracture, or uncertainty of the application or accuracy of the screening tools," write the authors. "Improved education of physicians may facilitate greater use of these rules."

It is also important to educate patients that these screening tools are effective and that imaging is not necessary if there are no signs of cervical injury. Follow-up strategies for patients discharged without imaging could be used to ease patient anxiety.

More information: www.cmaj.ca/lookup/doi/10.1503/cmaj.120675

Related Stories

Neck strength, cervical spine mobility don't predict pain

May 25, 2012

(HealthDay) -- Neither isometric neck muscle strength nor passive mobility of the cervical spine, two physical capacity parameters found to be associated with neck pain in other studies, predicts later neck pain in pain-free ...

Recommended for you

Experimental MERS vaccine shows promise in animal studies

July 28, 2015

A two-step regimen of experimental vaccines against Middle East respiratory syndrome (MERS) prompted immune responses in mice and rhesus macaques, report National Institutes of Health scientists who designed the vaccines. ...

Can social isolation fuel epidemics?

July 21, 2015

Conventional wisdom has it that the more people stay within their own social groups and avoid others, the less likely it is small disease outbreaks turn into full-blown epidemics. But the conventional wisdom is wrong, according ...

Lack of knowledge on animal disease leaves humans at risk

July 20, 2015

Researchers from the University of Sydney have painted the most detailed picture to date of major infectious diseases shared between wildlife and livestock, and found a huge gap in knowledge about diseases which could spread ...

IBD genetically similar in Europeans and non-Europeans

July 20, 2015

The first genetic study of inflammatory bowel disease (IBD) to include individuals from diverse populations has shown that the regions of the genome underlying the disease are consistent around the world. This study, conducted ...

0 comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.