cervical imaging referral

NEXUS criteria for cervical spine imaging

• focal neurologic deficit

• midline spinal tenderness

• altered level of consciousness

• intoxication

• distracting injury

SN/SP of NEXUS criteria

SN: 99.6%

SP: 12.9%

Canadian C spine rules (CCR)

what is radiography refering to in the canadian C-spine rules

CT scan

High risk factors for CCR

• >65 y/o

• paresthesias in extremities

• dangerous mechanism

  • falls from >3 ft/5 stairs

  • axial load to head

  • MVA w/ high speed, rollover, or ejection

  • bicycle collision

  • motorized recreational vehicle accident

low-risk factors on CCR

• simple rear-end motor vehicle crash

• pt in sitting position in ED

• pt ambulatory at any time after trauma

• delayed onset of neck pain

• absence of midline cervical spine tenderness

SN/SP of CCR

SN: 100%

SP: 43%

cervical red flags

• constitutional s/s

• immunosuppression

• Hx of malignancy or unexplained weight loss of insidious onset

• >50 y/o

• prolonged use of corticosteroids, osteoporosis

• suspected/dx rheumatological condition

• neurological s/s

  • headache

  • dysphagia

  • vomiting

  • focal neuro deficit

headache red flags

• thunderclap

• progressively worsening headache

• new headache in older pop

• new onset in a pt w/ hx of cancer or immunodeficiency syndrome

• headache with mental state changes

• fever/stiff neck/meningeal signs

• causing wakening from sleep

• focal neurological deficits if not previously recognised in the context of a migrainous aura

• pt with recent ingestion of amphetamine/cocaine

• worsening with valsalva

• significant trauma

• hx of seizures in non-epileptic

• different than usual migraine