C-spine Clearance

NEXUS criteria for C-spine Clearance

Let’s list down the NEXUS criteria with two versions of the mnemonic. Remember either one of these:

Mnemonic: NEXUS

1. Neurologic deficit (focal)

2. Ethanol/Intoxication

3. eXtreme distracting injury (painful injury elsewhere that could distract patient from recognizing the pain associated with a neck injury)

4. Unable to provide history (altered mental status)

5. Spinal tenderness (midline)

Mnemonic: NSAID

1. Neurologic deficit (focal)

2. Spinal tenderness (midline)

3. Altered mental status

4. Intoxication

5. Distracting injury (painful injury elsewhere that could distract patient from recognizing the pain associated with a neck injury)

Presence of any one of these indicates C-spine radiograph and continuing C-spine immobilization.

Canadian C-spine Rule (CCR) for C-spine Clearance

Mnemonic:

a. High risk features: Sixty five, Fast drive, Sense deprive? Image, if alive

b. Low risk features: Slow wreck, Slow neck, Sitting down, Walking ’round, C-spine fine? Range the spine!

Ultimately: If you can look both ways, you can cross the road without imaging

Canadian C-spine rule

Dangerous mechanism:

  1. Fall from elevation ≥3 feet/5 stairs
  2. Axial load to head e.g. diving
  3. MVC high speed (≥100 km/hr), rollover or ejection
  4. Motorized recreational vehicles e.g. ATV
  5. Bicycle collision

Simple rear-end MVC collision:

  1. Pushed into oncoming traffic
  2. Hit by bus/large truck
  3. Rollover
  4. Hit by high speed vehicle (≥100 km/hr)

For alert patients with trauma who are in stable condition, the CCR is superior to the Nexus criteria with respect to sensitivity and specificity for cervical-spine injury, and its use would result in reduced rates of radiography.

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