Canadian C-spine Rule versus NEXUS in Screening of Clinically Important Traumatic Cervical Spine Injuries,a systematic review and meta-analysis

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Vazirizadeh Mahabadi Mohammad Hossein; Yarahmadi Mobina

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Journal: Archives of Academic Emergency Medicine Year:621 | Volume: | Issue: Page(s): 0-0

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Title

Canadian C-spine Rule versus NEXUS in Screening of Clinically Important Traumatic Cervical Spine Injuries,a systematic review and meta-analysis

Author(s)

Vazirizadeh Mahabadi Mohammad Hossein | Yarahmadi Mobina | Issue Writer Certificate

Keywords

Spinal cord injuries

cervical cord

wounds and injuries

diagnosis

clinical decision rules

sensitivity and specificity

Abstract

Introduction: The Canadian C-spine Rule (CCR) and the National Emergency X-Radiography Utilization Study (NEXUS) are two criteria designed to rule-out clinically important traumatic cervical Spinal Cord Injury (SCI). In this systematic review and meta-analysis, we reviewed the articles comparing the performance of these two models. Methods: Search was done in Medline, Embase, Scopus and Web of Science until June 2022. Observational studies with direct comparison of CCR and NEXUS criteria in detection of clinically important cervical SCI were included. Two independent reviewers screened the relevant articles and summarized the data. Certainty of evidence was assessed based on QUADAS-2. Data were recorded as true positive, true negative, false positive, and false negative. Then, using “, diagma”,package and applying weighted random effect model, area under the receiver operating characteristic (ROC) curve (AUC), sensitivity, specificity, negative likelihood ratio, positive likelihood ratio, and diagnostic odds ratio (DOR)were calculated with 95% confidence interval (95%CI). Results: We included 5 studies with direct comparison. Area under the ROC curve of NEXUS in screening of patients with clinically important cervical SCI was 0. 708 (95% CI: 0. 647 to 0. 762). Pooled sensitivity and specificity of NEXUS criteria in screening of patients with clinically important cervical SCI were 0. 899 (95% CI: 0. 845 to 0. 936) and 0. 398 (95% CI: 0. 315 to 0. 488). The positive and negative likelihood ratios of NEXUS were 1. 494 (95% CI: 1. 146 to 1. 949) and 0. 254 (95% CI: 1. 155 to 1. 414), respectively. Diagnostic odds ratio of NEXUS was 5. 894 (95% CI: 3. 372 to 10. 305). Furthermore, area under the ROC curve of CCR in screening of clinically important cervical SCI was 0. 793 (95% CI: 0. 657 to 0. 884). Meta-analysis results showed that pooled sensitivity of CCR criteria in screening of patients with clinically important cervical SCI was 0. 987 (95%CI: 0. 957 to 0. 996) and specificitywas 0. 167 (95% CI: 0. 073 to 0. 336). The positive and negative likelihood ratios of CCR were 1. 184 (95% CI: 0. 837 to 1. 675) and 0. 081 (95% CI: 0. 021 to 0. 308), respectively. Diagnostic odds ratio of CCR was 14. 647 (95% CI: 3. 678 to 58. 336). Conclusion: Based on studies, both CCR and NEXUS were sensitive rules that have the potential to reduce unnecessary imaging in cervical spine trauma patients. However, the low specificity and false-positive results of both of these tools indicate that many people will continue to undergo unnecessary imaging after screening of cervical SCI using these tools. In this meta-analysis, CCR appeared to have better screening accuracy.

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References

Value of Canadian C-spine rule versus the NEXUS criteria in ruling out clinically important cervical spine injuries: derivation of modified Canadian C-spine rule

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APA: Copy

Vazirizadeh Mahabadi, Mohammad Hossein, & Yarahmadi, Mobina. (2023). Canadian C-spine Rule versus NEXUS in Screening of Clinically Important Traumatic Cervical Spine Injuries,a systematic review and meta-analysis. ARCHIVES OF ACADEMIC EMERGENCY MEDICINE (EMERGENCY), 11(1), 0-0. SID. https://sid.ir/paper/1114967/en

Vancouver: Copy

Vazirizadeh Mahabadi Mohammad Hossein, Yarahmadi Mobina. Canadian C-spine Rule versus NEXUS in Screening of Clinically Important Traumatic Cervical Spine Injuries,a systematic review and meta-analysis. ARCHIVES OF ACADEMIC EMERGENCY MEDICINE (EMERGENCY)[Internet]. 2023;11(1):0-0. Available from: https://sid.ir/paper/1114967/en

IEEE: Copy

Mohammad Hossein Vazirizadeh Mahabadi, and Mobina Yarahmadi, “Canadian C-spine Rule versus NEXUS in Screening of Clinically Important Traumatic Cervical Spine Injuries,a systematic review and meta-analysis,” ARCHIVES OF ACADEMIC EMERGENCY MEDICINE (EMERGENCY), vol. 11, no. 1, pp. 0–0, 2023, [Online]. Available: https://sid.ir/paper/1114967/en

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