Paykin Gabriel, O'Reilly Gerard, Ackland Helen M, Mitra Biswadev
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.
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.
Injury. 2017 May;48(5):1020-1024. doi: 10.1016/j.injury.2017.02.013. Epub 2017 Feb 22.
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.
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.
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%].
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.
国家急诊X线摄影利用研究（NEXUS）标准用于评估损伤后评估颈椎完整性所需的影像学检查。本研究的目的是评估NEXUS标准在老年钝性创伤患者中的敏感性。
从机构创伤登记处识别出2010年7月1日至2014年6月30日期间就诊且年龄在65岁及以上、被诊断为颈椎骨折的患者。从电子病历中提取临床检查结果。收集有关NEXUS标准的数据，并计算该规则排除骨折的敏感性。
在研究期间，231,018名患者前往阿尔弗雷德急诊与创伤中心就诊，其中14,340名符合机构创伤登记纳入标准，4035名年龄≥65岁。在这些患者中，468名被诊断为颈椎骨折，其中21名被判定为NEXUS阴性。在老年钝性创伤患者的完整病例分析中，NEXUS标准的敏感性为94.8%[95%CI：92.1%-96.7%]。单向敏感性分析得出的最大敏感性限值为95.5%[95%CI：93.2%-97.2%]。
与一般成年钝性创伤人群相比，NEXUS标准在排除老年钝性创伤患者颈椎骨折方面的敏感性较低。因此，我们建议无论病史或检查结果如何，都应考虑对老年患者进行更广泛的影像学检查，并在未来研究中探讨在NEXUS标准中增加年龄标准。
