![]() The comparison study 5 was conducted in the same hospitals and with the same physicians as the original Canadian C-Spine Rule study. Although these findings seem to suggest that the Canadian C-Spine Rule is more accurate, there were several possible biases against the NEXUS criteria. 5 This study showed that, compared with the NEXUS criteria, the Canadian C-Spine Rule was more sensitive (99.4 versus 90.7 percent) and more specific (45 versus 37 percent) in its intended population. The Canadian C-Spine Rule 2 ( Figure 1 5 ) was prospectively validated in 8,283 Canadian patients it also was compared to the NEXUS criteria in a large clinical trial. The patient with the second missed injury did not have neck pain but had a fracture at the right lamina of C-6 that eventually required laminectomy and fusion. Of the latter two missed injuries, one was described in one report (but not in others) as an “extension teardrop” fracture the patient refused treatment and was asymptomatic at six weeks. The NEXUS criteria correctly identified 810 out of 818 patients (99.0 percent) with C-spine injury and 576 out of 578 patients (99.7 percent) with clinically significant injury. The study included a broad range of patients, the age range was one to 101 years, and intoxicated patients were included. ![]() 3 Patients who did not have C-spine radiography or who had the test for reasons other than trauma were excluded. health centers with blunt trauma who underwent C-spine radiography. 1 The largest of these prospective validation studies included 34,069 patients presenting to 21 U.S. The National Emergency X-Radiography Utilization Study (NEXUS) low-risk criteria for C-spine radiography in patients with blunt trauma ( Table 1 1 ) were developed and validated over a 10-year period.
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