Canadian C-spine rule (CCR) versus national emergency X- radiography utilization study (NEXUS) for screening cervical spine injury

Abstract

Background: There is uncertainty about the optimal guidelines for screening clinically important cervical spine injuries following blunt trauma. The Canadian C Spine rule (CCR) and the National Emergency X Radiography Utilization system (NEXUS) are two widely accepted guidelines to help emergency physicians and trauma surgeons in case of cervical blunt trauma. Methods: We conducted a prospective analytical study between June 2019 to July 2020 at Mahatma Gandhi Mission's Hospital (MGM), Navi Mumbai comparing the diagnostic accuracy of CCR and NEXUS as applied to alert patients with trauma who were in stable condition. Result: Among the 400 trauma patients randomly selected for the study 280(70%) patients were male and 120(30%) were female. According to the NEXUS guidelines, 202(50.5%) patients and according to the CCR guidelines 210(52.5%) patients required radiography, however as per the results obtained from the cervical spine imaging only 20 (5%) patients had cervical spine injury. Both the NEXUS and CCR guidelines had similar true positive and false negative rates of 5% and 0.5% respectively. Both tests had sensitivity of about 91% and specificity 56.54% and 45.54% respectively. Conclusion: Based on studies with modest methodologic quality and only one direct comparison indicated that both CCR and NEXUS carry the same sensitivity for evaluating which patients need to undergo cervical spine imaging. Further the NEXUS guidelines have the same effectiveness as CCR for determining which patients must be subjected to cervical spine imaging.