Hi Michael
Thanks for posting the inclusion criteria that were used in the
validation of the tool......and provoking me to look further into this.
Oddly (to me) the poster and the pocket card that OHRI (the organisation
that the CCR comes from) produce are __much more vague_ about inclusion
criteria (for using the _Rule_ )....they say only '..where cervical
spine injury is a concern' (there is no footnote or annotation to
enlarge on this statement).
My thought is that if someone said 'when attending to someone from an
ATV rollover is cervical spine injury something that you should be
concerned about?' - many folks would likely answer 'yes'......which, if
they are using CCR poster/card, takes them into the algorithm.....and
then they get to x-ray because of mechanism, and so they get x-rayed.
ie. the _presentation_ of the Rule (and let's remember, it calls itself
a 'rule') itself may give rise to misapplication of the rule
It just all feels a bit unclean/unclear, in an area where clarity might
be quite important......and certainly when the Rule holds itself up as
better than the NEXUS criteria, and the authors suggest that NEXUS might
be dangerous (I am not lobbying for NEXUS here), based on a few percent
difference in the NEJM published study (the comparison of CCR vs NEXUS
that was conducted by the authors of CCR)...that few percent difference
might turn around the other way if the CCR rule presents itself using
materials that do not represent how the CCR was used in those studies.
Thoughts ?
Thanks all
Jel
Michael Stewart wrote:
> Jel
>
> It's in the department guidelines where I work. However, the original
> description doesn't mention imaging based solely on mechanism (nor
> x-raying everyone aged over 65 who walks into the department). The
> inclusion criteria were:
>
> - neck pain from any mechanism of injury
> - no neck pain but had all of the following:
> - some visible injury above the clavicles
> - had not been ambulatory
> - had sustained a dangerous mechanism of injury
--
Jel
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