NECK INJURIES

Absence of the following criteria predicted a very low probability (near 100% sensitivity) of significant injury noted on c-spine x-rays (standard 3-view series) in a validation study using a series of 34,069 pts 1-101yo presenting to an ED with blunt neck trauma ("NEXUS" study, NEJM 343:94, 2000--JW):

• Midline cervical tenderness
• Pain elsewhere that might distract the pt from noting cervical spine pain
• Focal neurologic deficit
• Altered alertness
• Intoxication

The following clinical decision rule was found to have sensitivity of 100% and specificity of 42.5% for detection of "clinically important" acute C-spine injury in pts presenting with blunt trauma to head & neck, stable VS, and Glasgow Coma Scale score of 15, in a prospective cohort study of 8924 adults (mean age 37yo) (JAMA 286:1841, 2001--JW)

• Must have NO high-risk factors present:
  • Age > 65yo
  • Dangerous mechanism:
    • Fall from > 1 meter/5 stairs
    • Axial load to head, e.g. diving
    • MVA at > 60MPH or rollover or ejection
    • Motorized recreational vehicle
    • Bicycle collision
  • Paresthesias in extremities
• Must have AT LEAST ONE of the following "low-risk" factors that allow safe assessment of range of motion:
  • Simple rear-end MVA
  • Able to sit in the ED
  • Ambulatory at any time
  • Delayed onset of neck pain (i.e., not immediate)
  • Absence of midline C-spine tenderness
• Ability to actively rotate neck 45' to left and right