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Selected Topics: Emergency Radiology| Volume 48, ISSUE 4, P445-449, April 2015

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Agreement Between Resident and Faculty Emergency Physicians in the Application of NEXUS Criteria for Suspected Cervical Spine Injuries

      Abstract

      Background

      The National Emergency X-Radiography Utilization Study (NEXUS) developed a decision rule for when cervical spine radiographs are required in the setting of trauma. To our knowledge, inter-rater reliability between resident and faculty emergency physicians has not been studied.

      Objective

      This study seeks to compare the inter-rater agreement of postgraduate year (PGY) 2–4 emergency medicine (EM) residents vs. EM faculty physicians.

      Methods

      A convenience sample of patients presenting to an urban, academic, Level II emergency department (ED) with complaints of cervical spine pain after trauma were enrolled. All subjects received separate examinations by an EM faculty physician and by a PGY 2–4 EM resident in a blinded fashion. Eighty subjects were enrolled in the study.

      Results

      Agreement for each of the NEXUS components were: posterior midline tenderness (PMT) 85.0% and κ = 0.70, intoxication (TOX) 95.0% and κ = 0.72, altered mental status (AMS) 87.5% and κ = 0.22, focal neurologic deficit (FND) 92.5% and κ = 0.21, and presence of a distracting injury (DIS) 88.8% and κ = 0.13. Overall agreement for need for radiographs was 77.5% and κ = 0.53. Sixty of the subjects received radiography (28 computed tomography, 40 plain films, 8 both). One fracture (C1 lamina) was detected in this dataset. Two of the five NEXUS criteria (PMT, TOX) demonstrated substantial agreement, two (AMS, FND) fair agreement, and one (DIS) slight agreement.

      Conclusions

      Based on our findings, there was considerable difference in agreement between staff physicians and residents. This could be due to the level of experience of the provider or the subjectiveness of components the criteria.

      Keywords

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      References

        • Dickinson G.
        • Stiell I.G.
        • Schull M.
        • et al.
        Retrospective application of the NEXUS low-risk criteria for cervical spine radiography in Canadian emergency departments.
        Ann Emerg Med. 2004; 43: 507-514
        • Bagley L.J.
        Imaging of spinal trauma.
        Radiol Clin N Am. 2006; 44: 1-12
        • Hoffman J.R.
        • Mower W.R.
        • Wolfson A.B.
        • et al.
        Validity of a set of clinical criteria to rule out injury to the cervical spine in patients with blunt trauma.
        N Engl J Med. 2000; 343: 94-99
        • Hoffman J.R.
        • Wolfson A.B.
        • Todd K.
        • et al.
        Selective cervical spine radiography in blunt trauma: methodology of the National Emergency X-Radiography Utilization Study (NEXUS).
        Ann Emerg Med. 1998; 32: 461-469
        • Hoffman J.R.
        • Schriger D.L.
        • Mower W.
        • et al.
        Low-risk criteria for cervical-spine radiography in blunt trauma: a prospective study.
        Ann Emerg Med. 1992; 21: 1454-1460
        • Meek R.
        • McGannon D.
        • Edwards L.
        The safety of nurse clearance of the cervical spine using the national emergency x-radiography utilization study low-risk criteria.
        Emerg Med Aust. 2007; 19: 372-376
        • Viera A.J.
        • Garrett J.M.
        Understanding interobserver agreement: the kappa statistic.
        Fam Med. 2005; 37: 360-363
        • Jekel J.F.
        • Elmore J.G.
        • Katz D.L.
        Epidemiology, biostatistics, and preventative medicine.
        WB Saunders, Philadelphia, PA1996: 96-97
        • Mahadevan S.
        • Mower W.R.
        • Hoffman J.R.
        • et al.
        Interrater reliability of cervical spine in jury criteria in patients with blunt trauma.
        Ann Emerg Med. 1998; 31: 197-201
        • Knopp R.
        Comparing NEXUS and Canadian c-spine decision rules for determining the need for cervical spine radiography.
        Ann Emerg Med. 2004; 43: 518-520