Evaluation of clinical criteria to determine the need for cervical spine imaging in victims of blunt assault

The purpose of this study is to evaluate effectiveness of clinical criteria, specifically the NEXUS Criteria, in determining the need for cervical spine imaging in victims of blunt assault to head and face. CT results from victims of blunt assault to the head and face were compared with presenting clinical findings. The presence or absence of cervical spine injury was correlated with positive NEXUS criteria to determine if the clinical criteria appropriately risk stratified patients in this population. Incidence of c-spine injury was 1.09% (7/641). For clinically significant injury, the incidence dropped to 0.16% (1/641). PPV of NEXUS criteria in blunt assault to the head and face for any injury in our study was 1.4% (95% CI: 0.6%-2.6%) compared to 2.7% (95% CI: 2.6%-2.8%) in the NEXUS validity study. PPV of NEXUS criteria in blunt assault to the head and face for significant injury in our study was 0.2% (95% CI: 0%-0.9%) compared to 1.9% (95% CI: 1.8%-2.0%) in the NEXUS validity study. The findings demonstrate a statistically significant difference between the PPV of NEXUS criteria in victims of blunt assault to the head and face when compared to all blunt trauma in the NEXUS validity study. This suggests that the clinical criteria do not adequately stratify this low risk population, leading to imaging over-utilization. Limited use of cervical spine imaging in victims of blunt assault will decrease radiation exposure and healthcare costs and will strengthen the validity of clinical risk stratification for more high-risk groups.