Publication:

Cervical spine fracture in geriatric blunt trauma: are the NEXUS criteria sensitive enough?

Background The NEXUS criteria lack an age consideration. This study characterizes NEXUS sensitivity for significant cervical fracture (CF) in non-geriatric (18-64 years) and geriatric (≥65 years) patients.

Methods This was a single-institution, retrospective review of blunt trauma patients (admitted between January 1, 2011 and December 31, 2016). Significant CF was an acute injury requiring surgery/orthosis. Propensity matching was used.

Results Overall, 353 patients had significant CF and notably 101 (28.6%) denied neck pain and tenderness at presentation. There were 162 geriatric patients with 17 patients who failed to meet any NEXUS criterion (sensitivity: 89.5%). The remaining 191 patients were non-geriatric, only six failed to meet any NEXUS criterion (sensitivity: 96.8%). NEXUS sensitivity was reduced among geriatric patients (89.5% vs. 96.8%, p=0.01), even after propensity matching (n=73/group; 86.3% vs. 97.3%, p=0.02).

Conclusions Alarmingly, 28.6% of patients with significant CF denied pain and tenderness. NEXUS demonstrated reduced sensitivity in the geriatric cohort, even after propensity matching. Liberal imaging is recommended for geriatric patients.