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Canadian C-Spine

Andrew Hunter, Jolion McGreevy, Judith Linden
Cervical spinal fracture is a rare, but potentially disabling complication of trauma to the neck. Clinicians often rely on clinical decision rules and guidelines to decide whether or not imaging is necessary when a patient presents with neck pain. Validated clinical guidelines include the Canadian C-Spine Rule and the Nexus criteria. Studies suggest that the risks of a pathologic fracture from a simple rear end collision are negligible. We present a case of an individual who presented to an emergency department (ED) after a low speed motor vehicle collision complaining of lateral neck pain and had multiple subsequent visits for the same complaint with negative exam findings...
May 23, 2017: American Journal of Emergency Medicine
S R Majumdar, D A Lier, D A Hanley, A G Juby, L A Beaupre
Fracture liaison services (FLS) are advocated to improve osteoporosis treatment after fragility fracture, but there are few economic analyses of different models. A population-based 1i [=type C] FLS for non-hip fractures was implemented and it costs $44 per patient and it was very cost-effective ($9200 per QALY gained). Small operational changes would convert it from cost-effective to cost-saving. INTRODUCTION: After fragility fracture, <20% of patients receive osteoporosis treatment...
March 9, 2017: Osteoporosis International
Amy H Y Cheng, Sam Campbell, Lucas B Chartier, Tom Goddard, Kirk Magee, Jill McEwen, Atul K Kapur, Brian R Holroyd, Suneel Upadhye, Stephanie Couperthwaite, Brian H Rowe
OBJECTIVES: Choosing Wisely Canada (CWC) is an initiative to encourage patient-physician discussions about the appropriate, evidence based use of medical tests, procedures and treatments. We present the Canadian Association of Emergency Physicians' (CAEP) top five list of recommendations, and the process undertaken to generate them. METHODS: The CAEP Expert Working Group (EWG) generated a candidate list of 52 tests, procedures, and treatments in emergency medicine whose value to care was questioned...
March 2, 2017: CJEM
Gillian Mazzetti, Claudie Berger, William D Leslie, Didier Hans, Lisa Langsetmo, David A Hanley, Christopher S Kovacs, Jerrilyn C Prior, Stephanie M Kaiser, K Shawn Davison, Robert Josse, Alexandra Papaioannou, Jonathan R Adachi, David Goltzman, Suzanne N Morin
Trabecular bone score (TBS) is a gray-level texture measure derived from lumbar spine dual-energy X-ray absorptiometry (DXA) images that predicts fractures independent of bone mineral density (BMD). Increased abdominal soft tissue in individuals with elevated body mass index (BMI) absorbs more X-rays during image acquisition for BMD measurement and must be accommodated by the TBS algorithm. We aimed to determine if the relationship between BMI and TBS varied between 2 major manufacturers' densitometers, because different densitometers accommodate soft tissues differently...
December 26, 2016: Journal of Clinical Densitometry
Matthew L Uriell, Jason W Allen, Brendan P Lovasik, Marc D Benayoun, Robert M Spandorfer, Chad A Holder
BACKGROUND: Computed tomography (CT) of the cervical spine (C-spine) is routinely ordered for low-impact, non-penetrating or "simple" assault at our institution and others. Common clinical decision tools for C-spine imaging in the setting of trauma include the National Emergency X-Radiography Utilization Study (NEXUS) and the Canadian Cervical Spine Rule for Radiography (CCR). While NEXUS and CCR have served to decrease the amount of unnecessary imaging of the C-spine, overutilization of CT is still of concern...
January 2017: Injury
M J Dadswell, S A Wehrell, A D Spares, M F Mclean, J W Beardsall, L M Logan-Chesney, G S Nau, C Ceapa, A M Redden, M J W Stokesbury
Atlantic sturgeon Acipenser oxyrinchus aggregate to feed from May to October in Minas Basin (45° N; 64° W), a large, cul-de-sac embayment of the inner Bay of Fundy. The aggregation consists mainly of migrants from the Saint John, NB and Kennebec Rivers, ME (99%). During 2004-2015, 4393 A. oxyrinchus were taken as by-catch by commercial fish trawlers or at intertidal fishing weirs, and 1453 were marked and/or sampled and released. Fork length (LF ) ranged from 458 to 2670 mm, but 72·5% were <1500 mm. Mass (M) ranged from 0·5 to 58·0 kg...
October 2016: Journal of Fish Biology
Sophie A Jamal, Victoria J D Swan, Jacques P Brown, David A Hanley, Jerilynn C Prior, Alexandra Papaioannou, Lisa Langsetmo, Robert G Josse
No abstract text is available yet for this article.
August 2016: American Journal of Kidney Diseases: the Official Journal of the National Kidney Foundation
Marc D Benayoun, Jason W Allen, Brendan P Lovasik, Matthew L Uriell, Robert M Spandorfer, Chad A Holder
BACKGROUND: Computed tomography (CT) of the cervical spine (C-spine) is routinely ordered for low-risk mechanisms of injury, including ground-level fall. Two commonly used clinical decision rules (CDRs) to guide C-spine imaging in trauma are the National Emergency X-Radiography Utilization Study (NEXUS) and the Canadian Cervical Spine Rule for Radiography (CCR). METHODS: Retrospective cross-sectional study of 3,753 consecutive adult patients presenting to an urban Level I emergency department who received C-spine CT scans were obtained over a 6-month period...
August 2016: Journal of Trauma and Acute Care Surgery
John Tran, Donald Jeanmonod, Darin Agresti, Khalief Hamden, Rebecca K Jeanmonod
INTRODUCTION: The National Emergency X-radiography Utilization Study (NEXUS) criteria are used extensively in emergency departments to rule out C-spine injuries (CSI) in the general population. Although the NEXUS validation set included 2,943 elderly patients, multiple case reports and the Canadian C-Spine Rules question the validity of applying NEXUS to geriatric populations. The objective of this study was to validate a modified NEXUS criteria in a low-risk elderly fall population with two changes: a modified definition for distracting injury and the definition of normal mentation...
May 2016: Western Journal of Emergency Medicine
Bruno Tirotti Saragiotto, Zoe A Michaleff
No abstract text is available yet for this article.
July 2016: Journal of Physiotherapy
Luciana Gazzi Macedo, Anna Bodnar, Michele C Battié
BACKGROUND CONTEXT: In routine clinical practice, the presence of lumbar spinal stenosis (LSS) is assessed on axial magnetic resonance images (MRI) typically acquired using a preselected spine sagittal angle. Given the natural lordosis of the lumbar spine, not all axial slices will be parallel to the disc and perpendicular to the spinal canal and, thus, are not optimal for the assessment of dural sac cross-sectional area (DCSA). PURPOSE: The objective of this study was to compare DCSA measurements from routinely acquired clinical images with three-dimensional (3D)-reconstructed images...
July 2016: Spine Journal: Official Journal of the North American Spine Society
Marc D Benayoun, Jason W Allen, Brendan P Lovasik, Matthew Uriell, Robert M Spandorfer, Chad A Holder
BACKGROUND: CT of the cervical spine is routinely ordered for low-risk mechanisms of injury, including ground level fall (GLF). Two commonly employed clinical decision rules (CDRs) to guide C-spine imaging in trauma are the National Emergency X-Radiography Utilization Study (NEXUS) and the Canadian Cervical Spine Rule for Radiography (CCR). METHODS: Retrospective cross-sectional study of 3,753 consecutive adult patients presenting to an urban Level I ED who received C-spine CT scans were obtained over a six month period...
March 30, 2016: Journal of Trauma and Acute Care Surgery
Tanya L Zakrison, Brian H Williams
BACKGROUND: Cervical spine injuries causing spinal cord trauma are rare in blunt trauma yet lead to devastating morbidity and mortality when they occur. There exists considerable debate in the literature about the best way for clinicians to proceed in ruling out cervical spine injuries in alert or obtunded blunt trauma patients. METHODS: We reviewed the current literature and practice management guidelines to generate clinical recommendations for the detection and clearance of cervical spine injuries in the blunt trauma patient...
September 2016: International Journal of Surgery
Catherine M Clement, Ian G Stiell, Maureen A Lowe, Jamie C Brehaut, Lisa A Calder, Christian Vaillancourt, Jeffrey J Perry
OBJECTIVES: We recently conducted a multicentre implementation study on the use of the Canadian C-Spine Rule (CCR) by emergency department (ED) nurses to clear the c-spine in alert and stable trauma patients (n = 4506). The objective of this study was to conduct a survey of nurses, physicians, and administrators to evaluate their views on the facilitators and barriers to the implementation of the CCR. METHODS: We conducted both a paper-based and an electronic survey of the three different ED hospital staff groups of nine large teaching hospitals in Ontario, including six regional trauma centres...
July 2016: International Emergency Nursing
Remko Soer, Albère J A Köke, Bert L G N Speijer, Patrick C A J Vroomen, Rob J E M Smeets, Maarten H Coppes, Michiel F Reneman, Douglas P Gross
STUDY DESIGN: Cross-sectional study. OBJECTIVE: To examine reference data for the Pain Disability Index (PDI) in Dutch and Canadian patient samples with a variety of musculoskeletal pain disorders and to test which potential factors are independently associated with the PDI score. SUMMARY OF BACKGROUND DATA: The PDI is a widely used generic instrument for measuring disability related to pain. It is unknown whether patients with spinal and other musculoskeletal diagnoses have different levels of disability when scored on the PDI...
May 1, 2015: Spine
Eugene V McCloskey, Anders Odén, Nicholas C Harvey, William D Leslie, Didier Hans, Helena Johansson, John A Kanis
The aim of the present study was to determine the impact of trabecular bone score on the probability of fracture above that provided by the clinical risk factors utilized in FRAX. We performed a retrospective cohort study of 33,352 women aged 40-99 years from the province of Manitoba, Canada, with baseline measurements of lumbar spine trabecular bone score (TBS) and FRAX risk variables. The analysis was cohort-specific rather than based on the Canadian version of FRAX. The associations between trabecular bone score, the FRAX risk factors and the risk of fracture or death were examined using an extension of the Poisson regression model and used to calculate 10-year probabilities of fracture with and without TBS and to derive an algorithm to adjust fracture probability to take account of the independent contribution of TBS to fracture and mortality risk...
June 2015: Calcified Tissue International
Kenji Inaba, Lauren Nosanov, Jay Menaker, Patrick Bosarge, Lashonda Williams, David Turay, Riad Cachecho, Marc de Moya, Marko Bukur, Jordan Carl, Leslie Kobayashi, Stephen Kaminski, Alec Beekley, Mario Gomez, Dimitra Skiada
BACKGROUND: Unlike the cervical spine (C-spine), where National Emergency X-Radiography Utilization Study (NEXUS) and the Canadian C-spine Rules can be used, evidence-based thoracolumbar spine (TL-spine) clearance guidelines do not exist. The aim of this study was to develop a clinical decision rule for evaluating the TL-spine after injury. METHODS: Adult (≥15 years) blunt trauma patients were prospectively enrolled at 13 US trauma centers (January 2012 to January 2014)...
March 2015: Journal of Trauma and Acute Care Surgery
Jerilynn C Prior, Lisa Langsetmo, Brian C Lentle, Claudie Berger, David Goltzman, Christopher S Kovacs, Stephanie M Kaiser, Jonathan D Adachi, Alexandra Papaioannou, Tassos Anastassiades, Tanveer Towheed, Robert G Josse, Jacques P Brown, William D Leslie, Nancy Kreiger
BACKGROUND: Population-based incident fracture data aid fracture prevention and therapy decisions. Our purpose was to describe 10-year site-specific cumulative fracture incidence by sex, age at baseline, and degree of trauma with/without consideration of competing mortality in the Canadian Multicentre Osteoporosis Study adult cohort. METHODS: Incident fractures and mortality were identified by annual postal questionnaires to the participant or proxy respondent. Date, site and circumstance of fracture were gathered from structured interviews and medical records...
February 2015: Bone
James C Worrall, Sadia Jama, Ian G Stiell
OBJECTIVES: Computed tomography (CT) use is increasing in the emergency department (ED). Many physicians are concerned about exposing patients to radiation from CT scanning, but estimates of radiation doses vary. This study's objective was to determine the radiation doses from CT scanning for common indications in a Canadian ED using modern multidetector CT scanners. METHODS: We conducted a health records review of consecutive adult patients seen at two busy tertiary care EDs over a 2-month period who underwent CT scanning ordered by emergency physicians...
November 2014: CJEM
Maria Bohr Dawids, Marie Lillevang-Johansen
A 77-year-old woman had a total luxation of C5-C6 after falling 1 m down a staircase. She presented with atypical symptoms, i.e. shoulder- and back pain, and later pareses of the left arm. The initial clinical findings did not warrant radiography, which delayed the correct diagnosis of her serious condition. When diagnosed she received surgical stabilization of her fractures. We recommend the use of a validated set of rules for radiography, e.g. Canadian C-spine Rule or National Emergency X-radiography Utilization Study low-risk criteria on all elderly patients admitted after fall-trauma to rule out cervical injury even with no typical symptoms...
May 12, 2014: Ugeskrift for Laeger
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