What are the criteria for clearing a spine without further radiologic imaging?

ACR Appropriateness Criteria for Imaging of Suspected Spine Trauma includes recommendations using the NEXUS or Canadian Cervical Spine Rule.

NEXUS Criteria
• Further imaging not required if ALL NEXUS criteria are met: no midline cervical tenderness, no focal neurologic deficit, normal alertness, no intoxication, no painful distracting injury

CCR Rule
• Obtain imaging if patient 1) age > 65 years, 2) experienced dangerous mechanism of injury, such as fall > 1 meter, axial load to head, motor vehicle collision with high speed, rollover or ejection, motorized recreational vehicle accident, or bicycle collision, or 3) has paresthesias in extremities, or 4) patient cannot actively rotate head rotate neck 45 degrees to left and right
• Obtain imagining unless patient has one of these low risk factors: 1) simple rear-end motor vehicle collision (excluding high-risk factors or impact by large vehicle), 2) sitting position in emergency department, 3) ambulatory at any time since injury, 4) delayed onset of neck pain, 5) absence of midline cervical spine tenderness

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About Amy

Clinical Informationist at EUH Branch Library
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