NEXUS vs. Canadian C-Spine Rule (CCR) in Predicting Cervical Spine Injuries; a Systematic Review and Meta-analysis

Area of Science:

• Emergency Medicine
• Radiology
• Clinical Decision Support

Background:

• Clinical decision tools reduce unnecessary imaging for suspected cervical spine injury (CSI).
• The diagnostic accuracy of the National Emergency X-Radiography Utilization Study (NEXUS) and Canadian C-spine rule (CCR) requires comprehensive evidence.

Purpose of the Study:

• To systematically review and synthesize evidence on the diagnostic performance of NEXUS and CCR for CSI detection.
• To compare the effectiveness of NEXUS and CCR in reducing imaging rates for suspected CSI.

Main Methods:

• Systematic literature review of studies published until January 26, 2023.
• Inclusion of studies on NEXUS and CCR performance in blunt trauma patients.
• Assessment of evidence quality using QUADAS-2 and GRADE guidelines.

Main Results:

• Review included 35 articles (70,000 patients for NEXUS, 33,000 for CCR).
• NEXUS sensitivity: 0.94 for any CSI, 0.95 for clinically important CSI.
• CCR sensitivity: 1.00 for any CSI, 1.00 for clinically important CSI.
• Area Under the Curve (AUC) for CCR was superior to NEXUS for both any CSI (0.97 vs. 0.85) and clinically important CSI (0.94 vs. 0.78).

Conclusions:

• Both NEXUS and CCR are effective in ruling out CSI in low-risk patients.
• The Canadian C-spine rule (CCR) exhibits superior diagnostic performance compared to NEXUS.
• Implementation of these tools can significantly decrease radiographic imaging in emergency departments.