title: The NEXUS criteria are insufficient to exclude cervical spine fractures in older blunt trauma patients.
abstract: OBJECTIVE
  The National Emergency X-Radiography Utilization Study (NEXUS) criteria are used to assess the need for imaging to evaluate cervical spine integrity after injury. The aim of this study was to assess the sensitivity of the NEXUS criteria in older blunt trauma patients.
  
  
  METHODS
  Patients aged 65 years or older presenting between 1st July 2010 and 30th June 2014 and diagnosed with cervical spine fractures were identified from the institutional trauma registry. Clinical examination findings were extracted from electronic medical records. Data on the NEXUS criteria were collected and sensitivity of the rule to exclude a fracture was calculated.
  
  
  RESULTS
  Over the study period 231,018 patients presented to The Alfred Emergency & Trauma Centre, of whom 14,340 met the institutional trauma registry inclusion criteria and 4035 were aged ≥65years old. Among these, 468 patients were diagnosed with cervical spine fractures, of whom 21 were determined to be NEXUS negative. The NEXUS criteria performed with a sensitivity of 94.8% [95% CI: 92.1%-96.7%] on complete case analysis in older blunt trauma patients. One-way sensitivity analysis resulted in a maximum sensitivity limit of 95.5% [95% CI: 93.2%-97.2%].
  
  
  CONCLUSIONS
  Compared with the general adult blunt trauma population, the NEXUS criteria are less sensitive in excluding cervical spine fractures in older blunt trauma patients. We therefore suggest that liberal imaging be considered for older patients regardless of history or examination findings and that the addition of an age criterion to the NEXUS criteria be investigated in future studies.
authors.affiliation: Department of Epidemiology & Preventive Medicine, Monash University, Melbourne, Australia; National Trauma Research Institute, The Alfred Hospital, Melbourne, Australia; Emergency & Trauma Centre, The Alfred Hospital, Melbourne, Australia.
authors.forename: Gabriel
authors.initials: G
authors.lastname: Paykin
authors.affiliation: Department of Epidemiology & Preventive Medicine, Monash University, Melbourne, Australia; National Trauma Research Institute, The Alfred Hospital, Melbourne, Australia; Emergency & Trauma Centre, The Alfred Hospital, Melbourne, Australia.
authors.forename: Gerard
authors.initials: G
authors.lastname: O'Reilly
authors.affiliation: Department of Epidemiology & Preventive Medicine, Monash University, Melbourne, Australia; National Trauma Research Institute, The Alfred Hospital, Melbourne, Australia; Intensive Care Department, The Alfred Hospital, Melbourne, Australia.
authors.forename: Helen M
authors.initials: HM
authors.lastname: Ackland
authors.affiliation: Department of Epidemiology & Preventive Medicine, Monash University, Melbourne, Australia; National Trauma Research Institute, The Alfred Hospital, Melbourne, Australia; Emergency & Trauma Centre, The Alfred Hospital, Melbourne, Australia. Electronic address: Biswadev.mitra@monash.edu.
authors.forename: Biswadev
authors.initials: B
authors.lastname: Mitra
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000465:Algorithms; D001315:Australia / Q000453:epidemiology; D002574:Cervical Vertebrae / Q000000981:diagnostic imaging* / Q000293:injuries; D003657:Decision Making; D004636:Emergency Service, Hospital; D005260:Female; D006801:Humans; D015601:Injury Severity Score; D008297:Male; D015995:Prevalence; D011446:Prospective Studies; D012680:Sensitivity and Specificity; D016103:Spinal Fractures / Q000000981:diagnostic imaging / Q000453:epidemiology; D014057:Tomography, X-Ray Computed; D014193:Trauma Centers / Q000706:statistics & numerical data; D014949:Wounds, Nonpenetrating / Q000000981:diagnostic imaging* / Q000453:epidemiology
keywords: Cervical vertebrae; NEXUS: emergency medicine; Spine; Wounds and injuries