The ACR does not take a position on the relative merits of the two sets of criteria; however, the ACR recognizes both are in widespread clinical practice and produce concordant predictions for most patients. Thus, either NEXUS or CCR may be applied to this ACR Appropriateness Criteria document. The NEXUS criteria identify 5 clinical factors that either place patients at increased risk for cervical spine injury or limit clinical assessment of injury (Table 1). Under the NEXUS criteria, imaging evaluation of the cervical spine is not indicated if none of the 5 clinical factors are present. The strength of the NEXUS criteria is its high sensitivity (99.6%) and negative predictive value (99.9%) for identifying significant cervical spine injury [4]. However, the NEXUS criteria have very low specificity (12.9%) [4]. A patient who meets the NEXUS criteria for cervical imaging is not necessarily likely to have sustained a significant cervical spine injury. The American College of Radiology seeks and encourages collaboration with other organizations on the development of the ACR Appropriateness Criteria through society representation on expert panels. Participation by representatives from collaborating societies on the expert panel does not necessarily imply individual or society endorsement of the final document. Reprint requests to: publications@acr.org Suspected Spine Trauma Table 1. NEXUS Criteria for Cervical Spine Imaging [4] The CCR criteria use a more complex algorithm for guiding cervical spine imaging in trauma patients than the NEXUS criteria. In the CCR criteria, patients deemed as high risk (Table 2) for cervical spine injury automatically undergo imaging evaluation of the cervical spine. Table 3. CCR Low-Risk Factors for Cervical Spine Injury [5] Simple rear-end motor vehicle crash Patient in sitting position in emergency center Patient ambulatory at any time after trauma Delayed onset of neck pain Absence of midline cervical spine tenderness
Suspected Spine Trauma PCAs. The ACR does not take a position on the relative merits of the two sets of criteria; however, the ACR recognizes both are in widespread clinical practice and produce concordant predictions for most patients. Thus, either NEXUS or CCR may be applied to this ACR Appropriateness Criteria document. The NEXUS criteria identify 5 clinical factors that either place patients at increased risk for cervical spine injury or limit clinical assessment of injury (Table 1). Under the NEXUS criteria, imaging evaluation of the cervical spine is not indicated if none of the 5 clinical factors are present. The strength of the NEXUS criteria is its high sensitivity (99.6%) and negative predictive value (99.9%) for identifying significant cervical spine injury [4]. However, the NEXUS criteria have very low specificity (12.9%) [4]. A patient who meets the NEXUS criteria for cervical imaging is not necessarily likely to have sustained a significant cervical spine injury. The American College of Radiology seeks and encourages collaboration with other organizations on the development of the ACR Appropriateness Criteria through society representation on expert panels. Participation by representatives from collaborating societies on the expert panel does not necessarily imply individual or society endorsement of the final document. Reprint requests to: publications@acr.org Suspected Spine Trauma Table 1. NEXUS Criteria for Cervical Spine Imaging [4] The CCR criteria use a more complex algorithm for guiding cervical spine imaging in trauma patients than the NEXUS criteria. In the CCR criteria, patients deemed as high risk (Table 2) for cervical spine injury automatically undergo imaging evaluation of the cervical spine. Table 3. CCR Low-Risk Factors for Cervical Spine Injury [5] Simple rear-end motor vehicle crash Patient in sitting position in emergency center Patient ambulatory at any time after trauma Delayed onset of neck pain Absence of midline cervical spine tenderness