Tran John, Jeanmonod Donald, Agresti Darin, Hamden Khalief, Jeanmonod Rebecca K
St. Luke's University Hospital, Department of Emergency Medicine, Bethlehem, Pennsylvania.
Carilion Clinic, Roanoke, Virginia.
West J Emerg Med. 2016 May;17(3):252-7. doi: 10.5811/westjem.2016.3.29702. Epub 2016 May 5.
The National Emergency X-radiography Utilization Study (NEXUS) criteria are used extensively in emergency departments to rule out C-spine injuries (CSI) in the general population. Although the NEXUS validation set included 2,943 elderly patients, multiple case reports and the Canadian C-Spine Rules question the validity of applying NEXUS to geriatric populations. The objective of this study was to validate a modified NEXUS criteria in a low-risk elderly fall population with two changes: a modified definition for distracting injury and the definition of normal mentation.
This is a prospective, observational cohort study of geriatric fall patients who presented to a Level I trauma center and were not triaged to the trauma bay. Providers enrolled non-intoxicated patients at baseline mental status with no lateralizing neurologic deficits. They recorded midline neck tenderness, signs of trauma, and presence of other distracting injury.
We enrolled 800 patients. One patient fall event was excluded due to duplicate enrollment, and four were lost to follow up, leaving 795 for analysis. Average age was 83.6 (range 65-101). The numbers in parenthesis after the negative predictive value represent confidence interval. There were 11 (1.4%) cervical spine injuries. One hundred seventeen patients had midline tenderness and seven of these had CSI; 366 patients had signs of trauma to the face/neck, and 10 of these patients had CSI. Using signs of trauma to the head/neck as the only distracting injury and baseline mental status as normal alertness, the modified NEXUS criteria was 100% sensitive (CI [67.9-100]) with a negative predictive value of 100 (98.7-100).
Our study suggests that a modified NEXUS criteria can be safely applied to low-risk elderly falls.
国家急诊X线摄影利用研究（NEXUS）标准在急诊科被广泛用于排除普通人群的颈椎损伤（CSI）。尽管NEXUS验证集纳入了2943名老年患者，但多例病例报告以及加拿大颈椎规则对将NEXUS应用于老年人群的有效性提出了质疑。本研究的目的是在低风险老年跌倒人群中验证一种修改后的NEXUS标准，该标准有两处改动：对分散注意力损伤的定义进行了修改，以及对正常精神状态的定义。
这是一项对到一级创伤中心就诊且未被分诊到创伤区的老年跌倒患者进行的前瞻性观察队列研究。研究人员纳入了基线精神状态正常且无神经功能缺损定位体征的未中毒患者。他们记录了中线颈部压痛、创伤体征以及其他分散注意力损伤的存在情况。
我们纳入了800名患者。由于重复纳入，排除了1例患者跌倒事件，4例失访，最终795例用于分析。平均年龄为83.6岁（范围65 - 101岁）。阴性预测值后的括号内数字表示置信区间。有11例（1.4%）颈椎损伤。117例患者有中线压痛，其中7例有颈椎损伤；366例患者有面部/颈部创伤体征，其中10例患者有颈椎损伤。将头部/颈部创伤体征作为唯一的分散注意力损伤，且基线精神状态为正常警觉状态，修改后的NEXUS标准敏感性为100%（CI[67.9 - 100]），阴性预测值为100（98.7 - 100）。
我们的研究表明，修改后的NEXUS标准可安全应用于低风险老年跌倒患者。
