NEXUS vs. Canadian C-Spine Rule (CCR) in Predicting Cervical Spine Injuries; a Systematic Review and Meta-analysis
Introduction: Clinical decision tools have been shown to reduce imaging rates for clearance of suspected cervical spine injury (CSI). This review provides more comprehensive evidence on the diagnostic capabilities of National Emergency X-Radiography Utilization Study (NEXUS) and Canadian C-spine ru...
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| Format: | Article |
| Language: | English |
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Shahid Beheshti University of Medical Sciences
2023-09-01
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| Series: | Archives of Academic Emergency Medicine |
| Subjects: | |
| Online Access: | https://journals.sbmu.ac.ir/aaem/index.php/AAEM/article/view/2143 |
| _version_ | 1797659868456288256 |
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| author | Alireza Baratloo Koohyar Ahmadzadeh Mohammad Mehdi Forouzanfar Mahmoud Yousefifard Mehri Farhang Ranjbar Behrooz Hashemi Seyed Hadi Aghili |
| author_facet | Alireza Baratloo Koohyar Ahmadzadeh Mohammad Mehdi Forouzanfar Mahmoud Yousefifard Mehri Farhang Ranjbar Behrooz Hashemi Seyed Hadi Aghili |
| author_sort | Alireza Baratloo |
| collection | DOAJ |
| description |
Introduction: Clinical decision tools have been shown to reduce imaging rates for clearance of suspected cervical spine injury (CSI). This review provides more comprehensive evidence on the diagnostic capabilities of National Emergency X-Radiography Utilization Study (NEXUS) and Canadian C-spine rule (CCR) in this regard.
Method: A systematic review of the current literature was performed on studies published until Jan 26th, 2023, in databases of Medline, Scopus, Web of Science, and Embase, investigating the performance of NEXUS and CCR in blunt trauma patients. QUADAS-2 and GRADE guidelines were used to assess the quality and certainty of evidence. All analyses were performed using the STATA 14.0 statistical analysis software.
Results: 35 articles comprising 70000 patients for NEXUS and 33000 patients for CCR were included in this review. NEXUS and CCR were evaluated to have a sensitivity of 0.94 (95% confidence interval (CI): 0.88 to 0.98) and 1.00 (95% CI: 0.98 to 1.00) in the detection of any CSI and 0.95 (95% CI: 0.89 to 0.98) and 1.00 (95% CI: 0.95 to 1.00) in the detection of clinically important CSI. The area under the curve (AUC) of NEXUS and CCR was 0.85 and 0.97 for any CSI and 0.78 (95% CI: 0.74 to 0.81) and 0.94 (95% CI: 0.91 to 0.96) for clinically important CSI.
Conclusion: Our study demonstrates that both NEXUS and CCR can be used in ruling out patients with low risk of CSI, and CCR was shown to have superior performance. Even though these tools have low specificity, their application can still greatly reduce the number of radiographic imaging performed in emergency departments.
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| first_indexed | 2024-03-11T18:21:24Z |
| format | Article |
| id | doaj.art-b5b54726c59441d99f9ecf69d0d3d9b0 |
| institution | Directory Open Access Journal |
| issn | 2645-4904 |
| language | English |
| last_indexed | 2024-03-11T18:21:24Z |
| publishDate | 2023-09-01 |
| publisher | Shahid Beheshti University of Medical Sciences |
| record_format | Article |
| series | Archives of Academic Emergency Medicine |
| spelling | doaj.art-b5b54726c59441d99f9ecf69d0d3d9b02023-10-15T10:22:06ZengShahid Beheshti University of Medical SciencesArchives of Academic Emergency Medicine2645-49042023-09-0111110.22037/aaem.v11i1.2143NEXUS vs. Canadian C-Spine Rule (CCR) in Predicting Cervical Spine Injuries; a Systematic Review and Meta-analysisAlireza BaratlooKoohyar Ahmadzadeh0Mohammad Mehdi ForouzanfarMahmoud YousefifardMehri Farhang RanjbarBehrooz HashemiSeyed Hadi AghiliPhysiology Research Center, Iran University of Medical Sciences, Tehran, Iran Introduction: Clinical decision tools have been shown to reduce imaging rates for clearance of suspected cervical spine injury (CSI). This review provides more comprehensive evidence on the diagnostic capabilities of National Emergency X-Radiography Utilization Study (NEXUS) and Canadian C-spine rule (CCR) in this regard. Method: A systematic review of the current literature was performed on studies published until Jan 26th, 2023, in databases of Medline, Scopus, Web of Science, and Embase, investigating the performance of NEXUS and CCR in blunt trauma patients. QUADAS-2 and GRADE guidelines were used to assess the quality and certainty of evidence. All analyses were performed using the STATA 14.0 statistical analysis software. Results: 35 articles comprising 70000 patients for NEXUS and 33000 patients for CCR were included in this review. NEXUS and CCR were evaluated to have a sensitivity of 0.94 (95% confidence interval (CI): 0.88 to 0.98) and 1.00 (95% CI: 0.98 to 1.00) in the detection of any CSI and 0.95 (95% CI: 0.89 to 0.98) and 1.00 (95% CI: 0.95 to 1.00) in the detection of clinically important CSI. The area under the curve (AUC) of NEXUS and CCR was 0.85 and 0.97 for any CSI and 0.78 (95% CI: 0.74 to 0.81) and 0.94 (95% CI: 0.91 to 0.96) for clinically important CSI. Conclusion: Our study demonstrates that both NEXUS and CCR can be used in ruling out patients with low risk of CSI, and CCR was shown to have superior performance. Even though these tools have low specificity, their application can still greatly reduce the number of radiographic imaging performed in emergency departments. https://journals.sbmu.ac.ir/aaem/index.php/AAEM/article/view/2143Spinal injuriesDiagnosisAccuracyClinical decision rules |
| spellingShingle | Alireza Baratloo Koohyar Ahmadzadeh Mohammad Mehdi Forouzanfar Mahmoud Yousefifard Mehri Farhang Ranjbar Behrooz Hashemi Seyed Hadi Aghili NEXUS vs. Canadian C-Spine Rule (CCR) in Predicting Cervical Spine Injuries; a Systematic Review and Meta-analysis Archives of Academic Emergency Medicine Spinal injuries Diagnosis Accuracy Clinical decision rules |
| title | NEXUS vs. Canadian C-Spine Rule (CCR) in Predicting Cervical Spine Injuries; a Systematic Review and Meta-analysis |
| title_full | NEXUS vs. Canadian C-Spine Rule (CCR) in Predicting Cervical Spine Injuries; a Systematic Review and Meta-analysis |
| title_fullStr | NEXUS vs. Canadian C-Spine Rule (CCR) in Predicting Cervical Spine Injuries; a Systematic Review and Meta-analysis |
| title_full_unstemmed | NEXUS vs. Canadian C-Spine Rule (CCR) in Predicting Cervical Spine Injuries; a Systematic Review and Meta-analysis |
| title_short | NEXUS vs. Canadian C-Spine Rule (CCR) in Predicting Cervical Spine Injuries; a Systematic Review and Meta-analysis |
| title_sort | nexus vs canadian c spine rule ccr in predicting cervical spine injuries a systematic review and meta analysis |
| topic | Spinal injuries Diagnosis Accuracy Clinical decision rules |
| url | https://journals.sbmu.ac.ir/aaem/index.php/AAEM/article/view/2143 |
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