Our study aims to validate this modified NEXUS criteria in a prospective study of low-risk elderly fall patients who are not triaged to the trauma bay. 13 However, this study was a retrospective review of higher risk elderly falls that were triaged to the trauma bay and probably represent a more injured group than those presenting to the average emergency department (ED). demonstrated an increased specificity with their modified NEXUS criteria compared to the original NEXUS criteria. 3 There are other studies that report a higher specificity when applying the NEXUS criteria, which range from 13%–46%. Normal alertness was substituted with the patient’s baseline mental status, and physical exam findings of trauma to the head or face were considered the only “distracting injuries.” With a specificity of only 12.9%, the NEXUS criteria has room for improvement to reduce unnecessary imaging. A modified NEXUS criteria was used, with more strict definitions of normal alertness and distracting injury. 13 demonstrated the validity of the NEXUS criteria in high-risk geriatric falls while maintaining a sensitivity of 100%. 9 Other groups have included patients with Glasgow Coma Scale (GCS) of ≥13, despite the original criteria specifying “normal alertness.” 10 Because a large proportion of elderly patients have a GCS of 14 despite having a normal level of alertness, 11, 12 it is important to determine if the NEXUS criteria can be applied to this cohort.Įvans et al. A paper comparing resident and attending interpretation of the NEXUS criteria found poor to fair agreement when interpreting altered mental status, focal neurologic abnormality, and distracting injury, but was limited by its relatively small sample size. One of the criticisms of the original NEXUS criteria is the subjective nature of some of the criteria used to distinguish an interpretable patient. 3 In the elderly population, however, there has been some reluctance to accept the reliability of NEXUS criteria 4 – 7 despite it having a demonstrated sensitivity of 99.6% 3 overall and a sensitivity of 100% (95% CI ) in the elderly cohort of the validation population. The National Emergency X-Radiography Utilization Study (NEXUS) criteria is a valuable clinical decision- making tool to rule out cervical spine injuries (CSI) in the general population without radiographic imaging. 2 One-year mortality rates are respectively 24.5% and 41.7%. 2 Associated with these cervical injuries is significant morbidity and mortality, with 30-day mortality rates of 13% in those without spinal cord injury and 28.4% in those with spinal cord injury. 1 According to a retrospective review of Medicare data between 20, the rate of elders presenting with cervical fractures has increased from 4.6 per 10,000 to 5.3 per 10,000, while rates of hip fractures have decreased during the same time period. Older individuals are more likely to be hospitalized after sustaining a traumatic injury and now account for up to 25% of trauma admissions. medical centers are becoming increasingly frequent. 2000 Jul 13 343(2):94-9.As the population ages, elder patients presenting to U.S. National Emergency X-Radiography Utilization Study Group. 1998 Oct 32(4):461-9.Īctual study - Validity of a set of clinical criteria to rule out injury to the cervical spine in patients with blunt trauma. Methodology - Selective cervical spine radiography in blunt trauma: methodology of the National Emergency X-Radiography Utilization Study (NEXUS). Ann Emerg Med. Some prefer the Canadian c-spine rule, which I find harder to recall. Specificity was low at 12.6%, PPV 2.7%, which has been one of the major complaints about NEXUS. The 5 NEXUS criteria, if all negative, were 99% sensitive (99.6% sensitive for clinically significant c-spine injury) and had a NPV of 99.8% (99.9% for clinically significant injury). This was a multi-center prospective observational cohort with over 34,000 patients with blunt trauma who were to undergo c-spine x-ray. Plus it can be applied in settings without ready access to x-ray or in the field. If a patient is low-risk based on clinical criteria, the c-spine may be cleared without any radiographs. Plain c-spine x-rays require a significant dose of radiation to get all the views. Also, we have learned that NEXUS is not as sensitive in elderly patients. Since this was published, we have shifted to predominantly CT imaging, which is more sensitive. The NEXUS criteria can be used to determine which patients do not need c-spine x-rays.