Table 1:

Characteristics of the included studies

StudyDesignCountryN%MaleMOIIndex testReference standard (% of patients who received it)No. of patients lost to follow-up (%)
Hoffman et al., 200010Prospective cross-sectionalUS34 06964.8NR
  • Index: NEXUS

  • Assessors: emergency physician

  • Training: yes

  • Radiography: minimum 3 views; additional views/investigations ordered at the discretion of treating physician (100)

0
Stiell et al., 20012Prospective cross-sectionalCanada8 92451.5MVC 67%
  • Index: Canadian C-spine rule

  • Assessors: emergency physicians, supervised residents

  • Training: yes

  • Radiography ordered at the discretion of the treating physician (68.9)

  • 14-day proxy (31.1)

577 (6.5)
Stiell et al., 200313Prospective cross-sectionalCanada8 28352.3MVC 67.2%
  • Index: Canadian C-spine rule and NEXUS

  • Assessors: resident emergency medicine physicians

  • Training: yes

  • Radiography ordered at the discretion of the treating physician (71.7)

  • 14-day proxy (28.2)

854 (10.3) indeterminate cases not included in the analysis
Dickinson et al., 200426Retrospective analysis of data from Stiell 200112Canada8 92451.5MVC 67%
  • Index: 5 NEXUS items approximated from 20-items collected prospectively

  • Assessors: emergency physicians, supervised residents

  • Training: yes

  • Radiography and computed tomography ordered at the discretion of the treating physician (68.9)

  • 14-day proxy (31.1)

577 (6.5)
Miller et al., 200619Prospective cross-sectionalUK460NRNR
  • Index: Canadian C-spine rule for immobilization

  • Assessors: nursing staff all grades

  • Training: yes

  • Radiography ordered at the discretion of the treating physician (45)

  • 14-day proxy, no. not reported

  • 21-day surveillance, no. not reported

NR
Rethnam et al., 200820Retrospective reviewUK114NRNR
  • Index: Canadian C-spine rule

  • Assessors: retrospective application of Canadian C-spine rule

  • Training: NR

  • Only patients who had cervical spine radiographs were included.

N/A, patients were included if radiography was conducted
Mahler et al., 200927Prospective cross-sectionalUS202NRNR
  • Index: 4 NEXUS items and clinical sobriety assessment tool (7 questions)

  • Assessors: emergency physicians

  • Training: NR

  • All patients underwent computed tomography (100)

0
Stiell et al, 200921Prospective cross-sectionalCanada3 62851.0MVC 70.1%
  • Index: Canadian C-spine rule

  • Assessors: emergency physicians.

  • Training: yes

  • Radiography ordered at the discretion of the treating physician (53.3)

  • 30 day surveillance of ED and neurosurgical centres

Radiography conducted in 47.2% of patients
Vaillancourt et al., 200922Prospective cross-sectionalCanada2 39350.2MVC 62.5%
  • Index: Canadian C-spine rule revised for paramedics

  • Assessors: paramedics

  • Training: yes

  • Radiography ordered at the discretion of the treating physician (52.9)

  • 14-day proxy (28.5)

444 (18.6)
Coffey et al., 201023Prospective cross-sectionalUK1 42050.4MVC 75.8%
  • Index: Canadian C-spine rule

  • Assessor: emergency physicians of all grades

  • Training: yes

  • Radiography ordered at the discretion of the treating physician (69.5)

  • 14-day proxy (18)

178 (12.5)
Stiell et al., 201024Prospective cross-sectionalCanada3 63346.4MVC 63%
  • Index: Canadian C-spine rule for immobilization

  • Assessors: experienced nurses in emergency department

  • Training: yes

  • Radiography ordered at the discretion of the treating physician (47.2)

  • 30-day surveillance of ED and neurosurgical centres

Radiography conducted in 47.2% of patients
Duane et al., 201125Prospective cross-sectionalUS3 20164NR
  • Index: approximation of Canadian C-spine rule (minus rotation)

  • Assessors: residents

  • Training: yes

  • All patients underwent computed tomography (100)

0
Duane et al., 201128Prospective cross-sectionalUS2 60665MVC, % NR
  • Index: NEXUS

  • Assessors: residents

  • Training: yes

  • All patients underwent computed tomography (100)

0
Griffith et al., 20117Retrospective analysis from radiology information record systemUS1 58959.3MVC 37.7%
  • Index: NEXUS

  • Assessors: 2nd and 3rd year radiology students

  • Training: evaluation of clinical records

  • Only patients who underwent cervical spine computed tomography were included.

NA, patients were included if computed tomography was conducted
Migliore et al., 201129Prospective cross-sectionalUS80NRNR
  • Index: NEXUS

  • Assessors: physicians, residents

  • Training: NR

  • Radiography or computed tomography (75)

10 (15)
  • Note: CT = computed tomography, ED = Emergency department, MOI = Mechanism of injury, MVC = motor vehicle collision, NA = not applicable; NEXUS = National X-radiography Utilization Study low risk criteria, NR = not reported.

  • The item “delayed onset of neck pain” was excluded because paramedics would assess patients before such delay.

  • Residents received a 5-min explanation as to using a standardized data collection form.