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Application of National Emergency X-Radiography Utilization Study (NEXUS) Criteria, the Canadian C-Spine Rule (CCR) and an Institutional Hybrid Model Among Children Aged 8 to 17 years in the Emergency Department: A Retrospective Review
Lesley Pepin, BA1, Sara Bressler, BA2, Jahn Avarello, MD1,3, Cameron Brenner, BA2, Alan Johnson, MD1,2, Yosef Dlugacz, PhD4, Jose Prince, MD1,3,6, Matthew Bank, MD1,5,6 and Robert A Silverman, MD, MS1,2,6; 1Hofstra North Shore-LIJ School of Medicine, Hempstead NY; 2North Shore LIJ, Forest Hills NY; 3Cohen Children's Medical Center, New Hyde Park NY; 4Krasnoff Institute of Quality Management, New Hyde Park NY; 5North Shore University Hospital, Manhasset NY; 6Feinstein Institute for Medical Research, Manhasset NY

Abstract:
CT scans are sensitive for cervical spine injuries (CSI), but exposure to ionizing radiation is of concern in children. NEXUS and CCR are trauma decision tools developed to reduce unnecessary c-spine imaging. The development and most validation studies took place in adults rather than children. We determined the number of potentially avoidable scans in trauma patients aged 8 to 17 had NEXUS, CCR and a new hybrid decision tool been applied. We conducted a retrospective chart review of children 8 to 17 years receiving cervical CT scans for trauma in two level I trauma centers from 1/2010 to 11/2013. Using data extracted from medical records, the CTs were labeled indicated, or not indicated, by the three tools. 432 patients aged 8 to 17 met inclusion criteria, with an average age of 14 years. 2.5% (11) had abnormal CT scans, and 1% (4) had clinically significant CSIs requiring intervention. NEXUS, the CCR and the hybrid tool did not recommend imaging in 24%, 16% and 3% respectively of children scanned (table 1). The tools missed none of the CSIs requiring medical intervention. To varying extents, these tools potentially reduce cervical CT imaging in children aged 8 to 17 without missing any serious cases. The small sample size is a limitation and larger studies are needed to further validate these tools in this older pediatric group.
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Objective:
To determine the number of cervical spine CT scans that could have potentially been avoided in children aged 8 to 17 presenting for acute trauma to the ED with use of NEXUS, Canadian C-spine Rule and a new hybrid decision tool.Objective Content:
NEXUS, the CCR and the hybrid tool did not recommend c-spine imaging in 24%, 16% and 3% respectively in the children presenting with acute trauma. To varying extents, these tools potentially reduce cervical CT imaging in children aged 8 to 17, without missing any serious cases.


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