Journal Club: NEXUS C-Spine
Journal Club: Nexus C-Spine
October 1, 2019
In this episode, Dr. Alex Kaminsky delves into cervical spine imaging with NEXUS author Dr. Jerry Hoffman, in this inaugural episode of Journal Club.
Jerome (Jerry) Hoffman, MD
Professor Emeritus UCLA School of Medicine.
Co-Founder EM Abstracts
Hospital Affiliation: UCLA
In this inaugural Journal Club episode, we discuss the over-utilization of cervical spine imaging in traumatic patients via landmark papers from the NEXUS group.
X-radiography of the C-spine has been widely replaced by CT-radiography, but the principles remain the same. Patient with low mechanism injuries are often over-irradiated due to physician fears of a statistically small percentage of true clinically significant C-spine injuries. Physicians often neglect to recognize the number needed to harm during diagnostic studies. This is particularly important in C-spine imaging as the anatomic target is directly adjacent to the radiosensitive thyroid gland.
With the Assistance of Dr. Hoffman (Primary Author), we will delve into the overall study with some advanced pearls.
Key Resources / References:
- Initial Paper: Hoffman JR, Wolfson AB, Todd KH, Mower WR. Selective cervical spine radiography in blunt trauma: methodology of the National Emergency X-Radiography Utilization Study (NEXUS). Ann Emerg Med 1998;32:461-469. PMID:9774931 https://www.ncbi.nlm.nih.gov/pubmed/9774931
- Hoffman JR, , Mower WR, Todd KH. Validity of a set of clinical criteria to rule out injury to the cervical spine in patients with blunt trauma. National Emergency X-Radiography Utilization Study Group. N Engl J Med. 2000;343(2):94-1. PMID: 10891516 https://www.nejm.org/doi/10.1056/NEJM200007133430203?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub%3dwww.ncbi.nlm.nih.gov
- NEXUS C-Spine is an INSTRUMENT designed to augment clinical judgement. It was designed to support common-sense practices.
- Criteria – 99.6% Sensitive (If all negative, reassured no significant fracture)
- No Focal Neurologic Deficit
- No Altered Consciousness
- No Intoxication – Requires Judgement (common sense)
- No Distracting Injury – Requires Judgement (common sense)
- Is a finger fracture? Is a corneal ulceration?
- No Midline Tenderness
- Study Highlights
- >34,000 Patients over 21 hospitals in 4 geographic US regions
- >800 true positive C-spine injuries identified
- Sensitivity reported at 99.6%
- Two clinically significant “misses” identified
- One likely chronic injury. No change in outcome at follow-up. Patient asymptomatic.
- One patient underwent surgical intervention
- Of note authors suggest patient actually did not meet NEXUS criteria as he had paresthesias
- NEXUS C-spine: Overall 12.6% reduction in C-spine imaging
Oct 14, 2020
Battling COVID Burnout in Emergency Medicine
With COVID surging, shifts in the emergency department have been rough, to say the least, and our wellness is more important than ever. This episode is all about burnout, self-compassion, and resilience - what we can do for ourselves, our patients, and each other. Host Kimberly Bambach speaks with renowned wellness expert Al'ai Alvarez.
Oct 14, 2020
Being a Dad in Medicine
Being a parent is tough. Being a parent AND a doctor is real tough. Join these dads - host Matt Dillon and guests Geoff Comp, Drew Kalnow, and Alex Waggener - as they meander through tips and tricks about the when's and what-if's of starting a family during your medical training and career. No experts to be found here, just a handful of dads doing their best and sharing their experiences.
Oct 14, 2020
EMRA*Cast & EMRA Critical Care Committee Journal Club
Fluid resuscitation in sepsis is a hotly debated and much-studied topic - and for good reason. Listen in as three emergency physicians discuss some of the landmark papers directing emergency care of these critically ill patients. Join host Dr. Ranjita Raghavan of Mount Sinai and guests Dr. Chad Meyers of Elmhurst Hospital Center and Dr. Dustin Slagle of ChristianaCare.