Abstract
Background
The incidence of cervical spine injuries (CSI) in people over 65 years of age from
low-energy mechanisms is far greater than in younger populations. Algorithms and decision
rules exist for selection of trauma patients requiring cervical spine imaging.
Objectives
To determine the validity of the NEXUS criteria in the elderly population with low-mechanism
injuries.
Methods
We prospectively conducted computed tomography (CT) imaging in patients > 65 years
of age presenting with fall from standing height or less to rule out predefined clinically
significant CSI. Eligible patients were prospectively categorized into NEXUS positive
or negative.
Results
There were 169 patients included in the final analyses. One hundred twenty (71%) patients
in the cohort were classified as “NEXUS positive.” Eleven patients (6.5% of the cohort)
had CSI detected on CT imaging of the cervical spine. Nine patients had clinically
significant CSI. The NEXUS decision instrument demonstrated 88.9% sensitivity (50.7–99.4%)
and 98% negative predictive value (NPV) (87.8–99.9%) in detecting clinically significant
CSI. The NEXUS decision instrument demonstrated 81.8% sensitivity (47.8–96.8%) and
95.9% NPV (84.9–99.3%) in detecting any CSI.
Conclusion
In our study, the NEXUS decision instrument was not a valid tool to rule out imaging
for patients > 65 years of age presenting after a fall from standing height or less.
We advocate the liberal use of CT imaging of the cervical spine in this cohort of
patients to rule out cervical spine injury.
Keywords
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Article info
Publication history
Published online: May 25, 2015
Accepted:
March 3,
2015
Received in revised form:
February 26,
2015
Received:
November 14,
2014
Identification
Copyright
© 2015 Published by Elsevier Inc. All rights reserved.
