Neck pain post blunt trauma is a very common ED problem.
This review looks very briefly at the two main clinical decision rules used in these patients: NEXUS and CCR.
One interesting feature that comes up going through the literature is that these decision rules were made with XR as the gold standard of imaging, something which has changed in the last few decades due to publications of papers showing XR having a sensitivity of roughly 50%.
However, both of these decision rules had very good follow up (telephone questionnaires in CCR and review of local neurosurgical records and quality assurance logs in NEXUS) without missed injuries being identified. Not sure what to do with that!
Personally, when possible I prefer to use the CCR rule due to the higher specificity, addition of ROM and a study which compared CCR to CT which showed no missed injuries (Population 3,200 with 192 fractures).
This article was interesting in that it’s results suggested that the CCR rule had a specificity of only .6% for C-spine fractures…which again I’m not sure how to interpret.
It’s reassuring to know that none were missed however.
Would be very keen to hear how other people approach this problem.
Mathen R, Prospective evaluation of multi-slice computed tomography versus plain radiographic cervical spine clearance in trauma patients, Journal of trauma, 2007, 62(6) 1427
Duane T, Canadian Cervical Spine rule compared with computed tomography: a prospective analysis, Journal of Trauma, 2011, 71(2), 352-355.