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

Yıl 2019, Cilt: 9 Sayı: 1, 100 - 107, 26.03.2019

Bora Kaya Erkman Sanrı Haldun Akoğlu Özlem Güneysel

Öz

ÖZET

Giriş ve amaç: Künt servikal travma hastalarında klinik olarak anlamlı yaralanmaları tanımlamak için

geliştirilen ilk karar kuralı National Emergency X-Radiography (NEXUS). NEXUS çalışmasında, negatif prediktif

değer(NPV)% 99,8 olarak belirlenmiştir. Kanada Servikal Omurga Kurallarının (KSOK) duyarlılığı % 99.4,

özgüllük % 45.1 ve NPV % 100 olarak bildirilmiştir. Bu çalışmanın amacı, servikal yaralanma riski olan Türk

hasta popülasyonu için NEXUS ve KSOK’'nın güvenilirliğini ve yararlılığını belirlemektir.

Gereç ve yöntem: Bu prospektif gözlemsel çalışmaya, 1 Ocak 2012 - 1 Nisan 2012 tarihleri arasında, akut

travma geçiren ve ambulansla ya da kendi imkanlarıyla hastaneye başvuran, servikal travmaya yol açabilecek

bir mekanizma ile yaralanan 16 yaşın üzerindeki, gebe olmayan, stabil, bilinçli hastaları kapsayan 225 hasta

dahil edilmiştir. Bu hastalar daha sonra NEXUS ve CCR geçerliliği için değerlendirildi. Veriler güncel istatistik

programında analiz edildi.

Bulgular: 225 hastanın 7’sinde servikal patoloji tespit edilmiştir. Patolojik görüntüleme bulgusu varlığını

belirleme açısından NEXUS’un duyarlılığı %93(%95 GA 83-97) ve özgüllüğü %1,3(%95 GA 0,2-5,1) olarak

bulunurken, KSOK’nin duyarlılığı %100 (%95 GA %56-100) ve özgüllüğü %3,2 (%95 GA %1,4-6,7) olarak tespit

edildi.

Sonuç: KSOK ve NEXUS düşük risk kriterlerinin acil serviste servikal patolojilerin dışlanmasında faydalı

olduğu, KSOK’nın, NEXUS düşük risk kriterleri ile karşılaştırıldığında daha güvenilir ve yararlı olduğu tespit

edilmiştir.

Anahtar Sözcükler: NEXUS; Kanada servikal omurga kuralları; 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

Anahtar Kelimeler

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

Kaynakça

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