Barry Thomas B, McNamara Robert M
Department of Emergency Medicine, Temple University Hospital, Philadelphia, Pennsylvania 19140, USA.
J Emerg Med. 2005 Nov;29(4):433-6. doi: 10.1016/j.jemermed.2005.05.006.
We report a case of a clinically significant cervical spine fracture in an elderly patient without midline cervical tenderness. Application of the NEXUS rule by the treating physicians ruled out the need for radiography. However, knowledge of the Canadian C-spine rule and clinical judgment prompted obtaining a three-view trauma series of the cervical spine and, when the patient's pain increased, a computed tomography scan of the cervical spine. A type III fracture of the dens was found. In review of the case it was recognized that application of the NEXUS rule for this patient was problematic regarding the assessment of mental status. Specifically, the treating physicians did not strictly adhere to the detailed explanations attached to the NEXUS criteria regarding mental status. Clinicians may wish to preferentially apply the Canadian rule for patients over the age of 64 years.
我们报告了一例老年患者发生具有临床意义的颈椎骨折，但无颈椎中线压痛。主治医生应用NEXUS规则排除了进行X线检查的必要性。然而，对加拿大颈椎规则的了解和临床判断促使对颈椎进行了颈椎三位创伤系列检查，并且当患者疼痛加剧时，进行了颈椎计算机断层扫描。结果发现齿状突III型骨折。回顾该病例时发现，应用NEXUS规则评估该患者的精神状态存在问题。具体而言，主治医生未严格遵循NEXUS标准中关于精神状态的详细解释。临床医生可能希望优先对64岁以上的患者应用加拿大规则。
