TY  - JOUR
PY  - 2015//
TI  - Falls and Implementation of NEXUS in the Elderly (The FINE Study)
JO  - Journal of emergency medicine
A1  - Denver, Dominique
A1  - Shetty, Amith
A1  - Unwin, Danielle
SP  - 294
EP  - 300
VL  - 49
IS  - 3
N2  - BACKGROUND: The incidence of cervical spine injuries (CSI) in people over 65 years of age from low-energy mechanisms is far greater than in younger populations. Algorithms and decision rules exist for selection of trauma patients requiring cervical spine imaging. <br><br>OBJECTIVES: To determine the validity of the NEXUS criteria in the elderly population with low-mechanism injuries. <br><br>METHODS: We prospectively conducted computed tomography (CT) imaging in patients > 65 years of age presenting with fall from standing height or less to rule out predefined clinically significant CSI. Eligible patients were prospectively categorized into NEXUS positive or negative. <br><br>RESULTS: There were 169 patients included in the final analyses. One hundred twenty (71%) patients in the cohort were classified as "NEXUS positive." Eleven patients (6.5% of the cohort) had CSI detected on CT imaging of the cervical spine. Nine patients had clinically significant CSI. The NEXUS decision instrument demonstrated 88.9% sensitivity (50.7-99.4%) and 98% negative predictive value (NPV) (87.8-99.9%) in detecting clinically significant CSI. The NEXUS decision instrument demonstrated 81.8% sensitivity (47.8-96.8%) and 95.9% NPV (84.9-99.3%) in detecting any CSI. <br><br>CONCLUSION: In our study, the NEXUS decision instrument was not a valid tool to rule out imaging for patients > 65 years of age presenting after a fall from standing height or less. We advocate the liberal use of CT imaging of the cervical spine in this cohort of patients to rule out cervical spine injury.<p />  <p>Language: en</p>
LA  - en
SN  - 0736-4679
UR  - http://dx.doi.org/10.1016/j.jemermed.2015.03.005
ID  - ref1
ER  -