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Validity and reliability of clinical prediction rules used to screen for cervical spine injury in alert low-risk patients with blunt trauma to the neck: part 2. A systematic review from the Cervical Assessment and Diagnosis Research Evaluation (CADRE) Collaboration

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Abstract

Purpose

To update findings of the 2000–2010 Bone and Joint Decade Task Force on Neck Pain and its Associated Disorders (Neck Pain Task Force) on the validity and reliability of clinical prediction rules used to screen for cervical spine injury in alert low-risk adult patients with blunt trauma to the neck.

Methods

We searched four databases from 2005 to 2015. Pairs of independent reviewers critically appraised eligible studies using the modified QUADAS-2 and QAREL criteria. We synthesized low risk of bias studies following best evidence synthesis principles.

Results

We screened 679 citations; five had a low risk of bias and were included in our synthesis. The sensitivity of the Canadian C-spine rule ranged from 0.90 to 1.00 with negative predictive values ranging from 99 to 100%. Inter-rater reliability of the Canadian C-spine rule varied from k = 0.60 between nurses and physicians to k = 0.93 among paramedics. The inter-rater reliability of the Nexus Low-Risk Criteria was k = 0.53 between resident physicians and faculty physicians.

Conclusions

Our review adds new evidence to the Neck Pain Task Force and supports the use of clinical prediction rules in emergency care settings to screen for cervical spine injury in alert low-risk adult patients with blunt trauma to the neck. The Canadian C-spine rule consistently demonstrated excellent sensitivity and negative predictive values. Our review, however, suggests that the reproducibility of the clinical predictions rules varies depending on the examiners level of training and experience.

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Acknowledgements

The authors acknowledge and thank Mrs. Sophie Despeyroux, librarian at the Haute Autorité de Santé, for her suggestions and review of the search strategy. The authors also acknowledge Dr. Jessica Wong, who provided methodological guidance and training for several co-authors. This research was undertaken, in part, thanks to funding and supervision from the Canada Research Chairs program to Dr. Pierre Côté, Canada Research Chair in Disability Prevention and Rehabilitation at the University of Ontario Institute of Technology.

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Authors and Affiliations

  1. Division of Graduate Education and Research, Canadian Memorial Chiropractic College (CMCC), 6100 Leslie Street, Toronto, ON, Canada

    N. Moser & H. Shearer

  2. Institut Franco-Européen de Chiropraxie, 72 chemin de la Flambère, 31300, Toulouse, France

    N. Lemeunier

  3. University of Ontario Institute of Technology (UOIT), UOIT-CMCC Centre for the Study of Disability Prevention and Rehabilitation, 2000 Simcoe St. N, Oshawa, ON, L1H 7K4, Canada

    N. Lemeunier, H. Shearer, D. Sutton & P. Côté

  4. Department of Orthopaedic Surgery, Occupational and Industrial Orthopaedic Centre, NYU Hospital for Joint Diseases, 63 Downing Street, New York, NY, 10014, USA

    D. Southerst

  5. Canadian Memorial Chiropractic College (CMCC), 6100 Leslie Street, Toronto, ON, Canada

    K. Murnaghan

  6. Faculty of Health Sciences, University of Ontario Institute of Technology (UOIT), 2000 Simcoe St. N, Oshawa, ON, Canada

    P. Côté

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  1. N. Moser
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Correspondence to N. Lemeunier.

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Funding

This study was funded by the Institut Franco-Européen de Chiropraxie, the Association Française de Chiropraxie and the Fondation de recherche en chiropraxie in France. None of these associations was involved in the collection of data, data analysis, interpretation of data, or drafting of the manuscript.

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Moser, N., Lemeunier, N., Southerst, D. et al. Validity and reliability of clinical prediction rules used to screen for cervical spine injury in alert low-risk patients with blunt trauma to the neck: part 2. A systematic review from the Cervical Assessment and Diagnosis Research Evaluation (CADRE) Collaboration. Eur Spine J 27, 1219–1233 (2018). https://doi.org/10.1007/s00586-017-5301-6

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