256 A Clinical Decision Rule for Thoracic and Lumbar Spine Fractures: Does the NEXUS Rule Work Below the Neck?

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Study Objectives: The National Emergency X-Radiography Utilization Study (NEXUS) rule, which screens for potential cervical (C-) spine injury, suggests that imaging is not warranted in patients with no midline tenderness, no focal neurologic deficit, normal alertness, no intoxication, and no distracting injury. This rule has a reported sensitivity of 91-100% and specificity of 13-37% for clinically significant injuries. No prior studies have examined whether a variation of this rule might be useful for detecting thoracic (T-) and lumbar (L-) spine injuries.