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

  • N. Moser
  • N. Lemeunier
  • D. Southerst
  • H. Shearer
  • K. Murnaghan
  • D. Sutton
  • P. Côté
Review

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.

Keywords

Neck pain Clinical prediction rule Canadian C-spine rule Nexus low-risk criteria Validity Reliability 

Supplementary material

586_2017_5301_MOESM1_ESM.docx (19 kb)
Supplementary material 1 (DOCX 18 kb)

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Copyright information

© Springer-Verlag GmbH Germany 2017

Authors and Affiliations

  1. 1.Division of Graduate Education and ResearchCanadian Memorial Chiropractic College (CMCC)TorontoCanada
  2. 2.Institut Franco-Européen de ChiropraxieToulouseFrance
  3. 3.University of Ontario Institute of Technology (UOIT), UOIT-CMCC Centre for the Study of Disability Prevention and RehabilitationOshawaCanada
  4. 4.Department of Orthopaedic Surgery, Occupational and Industrial Orthopaedic CentreNYU Hospital for Joint DiseasesNew YorkUSA
  5. 5.Canadian Memorial Chiropractic College (CMCC)TorontoCanada
  6. 6.Faculty of Health SciencesUniversity of Ontario Institute of Technology (UOIT)OshawaCanada

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