Oct 1, 2019
Host: Alex Kaminsky MD: PGY-3 UCSF Fresno
Guest: Jerry Hoffman MD: Professor Emeritus UCLA
Deputy Editor/Contributor: Mat Goebel MD: PGY-1 Baystate
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.
Criteria – 99.6% Sensitive (If all negative, reassured no significant fracture)
>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
NEXUS C-spine: Overall 12.6% reduction in C-spine imaging