TRAVMALI HASTALARDA KANADA SERVİKAL OMURGA KURALLARI VE NEXUS DÜŞÜK RİSK KRİTERLERİNİN GEÇERLİLİĞİ The Validity of Canadian Cervical Spine Rules and the Nexus Low Risk Criteria in Trauma Patients

OZET Giris ve amac: Kunt servikal travma hastalarinda klinik olarak anlamli yaralanmalari tanimlamak icin gelistirilen ilk karar kurali National Emergency X-Radiography (NEXUS). NEXUS calismasinda, negatif prediktif deger(NPV)% 99,8 olarak belirlenmistir. Kanada Servikal Omurga Kurallarinin (KSOK) duyarliligi % 99.4, ozgulluk % 45.1 ve NPV % 100 olarak bildirilmistir. Bu calismanin amaci, servikal yaralanma riski olan Turk hasta populasyonu icin NEXUS ve KSOK’'nin guvenilirligini ve yararliligini belirlemektir. Gerec ve yontem: Bu prospektif gozlemsel calismaya, 1 Ocak 2012 - 1 Nisan 2012 tarihleri arasinda, akut travma geciren ve ambulansla ya da kendi imkanlariyla hastaneye basvuran, servikal travmaya yol acabilecek bir mekanizma ile yaralanan 16 yasin uzerindeki, gebe olmayan, stabil, bilincli hastalari kapsayan 225 hasta dahil edilmistir. Bu hastalar daha sonra NEXUS ve CCR gecerliligi icin degerlendirildi. Veriler guncel istatistik programinda analiz edildi. Bulgular: 225 hastanin 7’sinde servikal patoloji tespit edilmistir. Patolojik goruntuleme bulgusu varligini belirleme acisindan NEXUS’un duyarliligi %93(%95 GA 83-97) ve ozgullugu %1,3(%95 GA 0,2-5,1) olarak bulunurken, KSOK’nin duyarliligi %100 (%95 GA %56-100) ve ozgullugu %3,2 (%95 GA %1,4-6,7) olarak tespit edildi. Sonuc: KSOK ve NEXUS dusuk risk kriterlerinin acil serviste servikal patolojilerin dislanmasinda faydali oldugu, KSOK’nin, NEXUS dusuk risk kriterleri ile karsilastirildiginda daha guvenilir ve yararli oldugu tespit edilmistir. Anahtar Sozcukler: NEXUS; Kanada servikal omurga kurallari; Servikal travma ABSTRACT Background: The first decision rule developed to identify clinically significant injuries in blunt cervical trauma patients is National Emergency X-Radiography Utilisation Study (NEXUS). In the NEXUS study, the negative predictive value (NPV) has been determined as 99.8%. Sensitivity of Canadian Cervical Spine Rules (CCR) was reported as 99.4%, specificity as 45.1% and NPV was reported as 100%. The objective of this study is to determine the reliability and utility of NEXUS and CCR for Turkish patient population that has a risk of cervical injury. Methods: This prospective observational study included 225 patients, all stable, conscious patients over 16 years of age who had acute trauma and were brought to the hospital with ambulances or using their own means and who had been injured by a mechanism that may cause cervical trauma, and without exclusion criteria. The patients included in the study were then evaluated for NEXUS and CCR validity. Results: When CCR was evaluated as a whole, it was determined that all pathological cases were identified using these rules. In terms of identifying the presence of pathological imaging finding the sensitivity of CCR was 100% (95% CI % 56-100) and specificity was 3.2% (95% CI 1.4-6.7%). NEXUS's sensitivity was calculated as 93% (95% CI 83-97) and specificity as 1.3%(95% CI 0.2-5.1). Conclusion: CCR and the NEXUS were determined to be useful in the emergency department for the exclusion of cervical pathologies. CCR were more reliable and useful when compared with the NEXUS. Keywords: NEXUS; Canadian rules; Cervical trauma