Samaritan Hospital, Troy, NY 12180, USA.
St. Luke's University Hospital, Bethlehem, PA 18015, USA.
Am J Emerg Med. 2014 Jan;32(1):67-70. doi: 10.1016/j.ajem.2013.08.062. Epub 2013 Oct 4.
In spite of general acceptance and validation of NEXUS (National Emergency X-Radiography Utilization Study) in the clearance of cervical spine (C-spine) immobilized patients, clinicians often elect to image NEXUS-negative patients in clinical practice.
We sought to determine which variables (patient age, mechanism of injury, provider level of training, provider self-reported motivation) contribute to the decision of emergency medicine providers to image NEXUS-negative patients.
This is a prospective observational study of patients with blunt trauma and risk for C-spine injury who did not meet "trauma team activation" criteria. Providers at one high-volume emergency department (ED) prospectively recorded NEXUS criteria, as well as rationale for imaging NEXUS-negative patients. Researchers then retrospectively queried the electronic medical record for patient age, mechanism of injury, and results of diagnostic imaging. Study data were analyzed with χ(2) and descriptive statistics.
Three hundred patients were enrolled; 169 patients received C-spine imaging, of whom 53 were NEXUS-negative. There was no difference in imaging of NEXUS-negative patients as a factor of medical provider level of training (P=0.42). Of NEXUS-negative patients receiving imaging, 51 (96%) were older than 65 years, and 52 were being evaluated for a fall on level ground. Imaging revealed 7 positive findings. Two of these injuries were in NEXUS-negative patients.
Regardless of level of training, providers in our ED often imaged patients who met NEXUS low-risk criteria. This was mot common in geriatric patients who presented after falls. This digression from NEXUS led to the diagnosis of significant injuries in 2 patients which would otherwise have been missed.
尽管 NEXUS（国家紧急 X 射线利用研究）在排除颈椎（C 脊柱）固定患者方面得到了普遍认可和验证，但临床医生在临床实践中经常选择对 NEXUS 阴性患者进行影像学检查。
我们旨在确定哪些变量（患者年龄、损伤机制、提供者的培训水平、提供者自我报告的动机）有助于急诊医生决定对 NEXUS 阴性患者进行影像学检查。
这是一项对钝性创伤且有 C 脊柱损伤风险但不符合“创伤小组激活”标准的患者的前瞻性观察研究。一家高容量急诊科的提供者前瞻性地记录了 NEXUS 标准以及对 NEXUS 阴性患者进行影像学检查的理由。然后，研究人员从电子病历中回顾性查询了患者的年龄、损伤机制和诊断影像学结果。使用 χ(2)和描述性统计对研究数据进行分析。
共纳入 300 名患者；169 名患者接受了 C 脊柱影像学检查，其中 53 名患者为 NEXUS 阴性。医疗提供者的培训水平并不是对 NEXUS 阴性患者进行影像学检查的因素（P=0.42）。在接受影像学检查的 NEXUS 阴性患者中，51 名（96%）年龄大于 65 岁，52 名患者是因为平地摔倒而接受评估。影像学检查发现了 7 处阳性发现。这其中 2 处损伤在 NEXUS 阴性患者中。
无论培训水平如何，我们急诊科的提供者经常对符合 NEXUS 低危标准的患者进行影像学检查。这种情况在老年患者中更为常见，他们是因平地摔倒而就诊。这种偏离 NEXUS 标准导致了 2 名患者的重要损伤得到诊断，否则这些损伤可能会被漏诊。
