Comparative Diagnostic Accuracy of the NEXUS Criteria and the Canadian C-Spine Rule in Cervical Spine Trauma

Mohammed Fabin  Kodithodi; Aswin  Abbas; Rameez  Roshan; Bimal  Govind; Swathy  Shanker

doi:10.18502/jabs.v16i1.20128

Mohammed Fabin Kodithodi Department of Emergency Medicine and Traumacare, KMCT Medical College, Calicut, India
Aswin Abbas Department of Emergency Medicine, Mother Care Hospital, Mannarkkad, India
Rameez Roshan Department of Orthopaedics, Government Medical College, Calicut, India
Bimal Govind Department of Neurosurgery, KMCT Medical College, Calicut, India
Swathy Shanker Department of PG studies and Research, KMCT Medical College, Calicut, India

DOI: https://doi.org/10.18502/jabs.v16i1.20128

Keywords: Cervical Spine Trauma, Diagnosis, NEXUS Criteria, Canadian C-Spine Rule

Abstract

Background & Objectives: Road traffic injuries are the fourth most common cause of death globally, according to surveys. The Canadian Cervical-Spine Rule (CCR) and the National Emergency X-Radiography Utilization Study (NEXUS) Low-Risk Criteria (NLC) are decision rules to guide the use of cervical-spine radiography in patients with trauma. In this study we aim to evaluate and compare the sensitivity and specificity of these rules in trauma patients for suspected C-spine injury.

Materials & Methods: 500 patients were prospectively enrolled, in the event of them meeting the criteria. They were subjected to radiologic studies (X-ray or CT) of the cervical spine if they met NEXUS criteria or the CCR.

Results: Of the 500 patients, 44.5% were subjected to radiography based on the NEXUS score and 58.8% based on the Canadian CCR. When the CCR was applied, the test was found to be 95.2% sensitive, 54.2% specific, 65% accurate, and with 42.6% positive predictive value and 97% negative predictive value. When NEXUS criteria were applied, sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were 100%, 75.3%, 59%, 100%, and 81.8%, respectively.

Conclusion: When the NEXUS score was applied, the diagnostic accuracy was better. With the CCR, a greater number of patients were subjected to radiological evaluation. Either of the two criteria may be applied for emergency care in the Indian population to avoid unnecessary investigations. CCR followed by NEXUS criteria is recommended, and the utilization of the same is to be studied in a larger population.