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West J Emerg Med. 2016 May;17(3):252-7. doi: 10.5811/westjem.2016.3.29702. Epub 2016 May 5.

Prospective Validation of Modified NEXUS Cervical Spine Injury Criteria in Low-risk Elderly Fall Patients.

Author information

1
St. Luke's University Hospital, Department of Emergency Medicine, Bethlehem, Pennsylvania.
2
Carilion Clinic, Roanoke, Virginia.

Abstract

INTRODUCTION:

The National Emergency X-radiography Utilization Study (NEXUS) criteria are used extensively in emergency departments to rule out C-spine injuries (CSI) in the general population. Although the NEXUS validation set included 2,943 elderly patients, multiple case reports and the Canadian C-Spine Rules question the validity of applying NEXUS to geriatric populations. The objective of this study was to validate a modified NEXUS criteria in a low-risk elderly fall population with two changes: a modified definition for distracting injury and the definition of normal mentation.

METHODS:

This is a prospective, observational cohort study of geriatric fall patients who presented to a Level I trauma center and were not triaged to the trauma bay. Providers enrolled non-intoxicated patients at baseline mental status with no lateralizing neurologic deficits. They recorded midline neck tenderness, signs of trauma, and presence of other distracting injury.

RESULTS:

We enrolled 800 patients. One patient fall event was excluded due to duplicate enrollment, and four were lost to follow up, leaving 795 for analysis. Average age was 83.6 (range 65-101). The numbers in parenthesis after the negative predictive value represent confidence interval. There were 11 (1.4%) cervical spine injuries. One hundred seventeen patients had midline tenderness and seven of these had CSI; 366 patients had signs of trauma to the face/neck, and 10 of these patients had CSI. Using signs of trauma to the head/neck as the only distracting injury and baseline mental status as normal alertness, the modified NEXUS criteria was 100% sensitive (CI [67.9-100]) with a negative predictive value of 100 (98.7-100).

CONCLUSION:

Our study suggests that a modified NEXUS criteria can be safely applied to low-risk elderly falls.

PMID:
27330655
PMCID:
PMC4899054
DOI:
10.5811/westjem.2016.3.29702
[Indexed for MEDLINE]
Free PMC Article

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