The safety of nurse clearance of the cervical spine using the National Emergency X‐radiography Utilization Study low‐risk criteria

Abstract

To determine the level of agreement between trained ED nursing staff and senior ED medical staff in the application and interpretation of the National Emergency X-radiography Utilization Study (NEXUS) low-risk criteria (NLC). A NEXUS training and accreditation package was developed. It was successfully undertaken by 22 senior ED nursing staff and 26 senior ED medical staff. A study nurse and doctor independently applied the NLC to a convenience sample of patients who had been placed in a hard cervical collar prior to arrival in the ED. The findings for each of the NLC and the overall decision regarding collar removal were recorded on specific case report forms. The primary endpoint was the level of agreement for the overall decision to leave the collar in place. Levels of agreement for the individual NLC were also examined. In total, 183 patients were recruited. The level of 'safe agreement' where nursing and medical staff agreed that the collar should be left in place was 94.3% (95% CI: 89.5-97.2%). Agreement with regard to individual NLC varied from good to fair. The median times from patient arrival to completion of study nurse and doctor assessments were 14 min (interquartile ranges [IQR] 5-30) and 29 min (IQR 15-47), respectively. The study demonstrated a high level of agreement between nursing and medical staff for stable low-risk trauma patients.