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Prevalence of midline cervical spine tenderness in the non-trauma population
  1. J Scott Delaney1,
  2. Ammar Al-Kashmiri2,
  3. Abdulaziz Alalshaikh3,
  4. Saif Al-Ghafri4,
  5. Sanjeet Singh Saluja1,
  6. Jose A Correa5
  1. 1Department of Emergency Medicine, McGill University Health Centre, Montreal, Québec, Canada
  2. 2Emergency Department, Khoula Hospital, Mina Al Fahal, Muscat, Oman
  3. 3Emergency Department, King Saud University, Riyadh, Riyadh Province, Saudi Arabia
  4. 4Emergency Department, Sultan Qaboos University, Muscat, Oman
  5. 5Department of Mathematics and Statistics, McGill University, Montréal, Québec, Canada
  1. Correspondence to Dr Ammar Al-Kashmiri, Emergency Department, Khoula Hospital, Mina Al Fahal, Muscat P.O.BOX 1720, P.C. 112, Oman; ammar.alkashmiri{at}moh.gov.om

Abstract

Objective The Canadian C-Spine Rule (CCR) and the National Emergency X-Radiography Utilization Study (NEXUS) criteria are two commonly used clinical decision rules which use midline cervical spine (c-spine) tenderness on palpation as an indication for c-spine imaging post-trauma. This study was undertaken to determine the prevalence and location of midline c-spine tenderness in the non-trauma population.

Methods We prospectively evaluated consenting adult patients presenting to an urban ED or university sport medicine clinic in Montreal, Canada between 2018 and 2020 for atraumatic non-head and neck-related reports over a 20-month period. The presence and location of pain during midline c-spine palpation as assessed by two examiners during separate evaluations was recorded. Patient information such as age, neck length and circumference, gender, body mass index (BMI) and scaphoid tenderness was also collected.

Results Of 478 patients enrolled, 286 (59.8%) had midline c-spine tenderness on palpation with both examiners. The majority of those with tenderness were female (70.6%). When examining all patients, tenderness was present in the upper third of the c-spine in 128 (26.8%) patients, middle third in 270 (56.5%) patients and lower third in 6 (1.3%) patients. Factors associated with having increased odds of midline c-spine tenderness on palpation included a lower BMI and the presence of scaphoid tenderness on palpation.

Conclusions There is a high prevalence of c-spine tenderness on palpation in patients who have not undergone head or neck trauma. This finding may help explain the low specificity in some of the validation studies examining the CCR and the NEXUS criteria.

  • clinical assessment
  • imaging
  • musculoskeletal
  • trauma

Data availability statement

Data are available upon reasonable request. All data relevant to the study are included in the article or uploaded as supplemental information.

Data availability statement

All data relevant to the study are included in the article.

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Data availability statement

Data are available upon reasonable request. All data relevant to the study are included in the article or uploaded as supplemental information.

Data availability statement

All data relevant to the study are included in the article.

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Footnotes

  • Handling editor David Metcalfe

  • Contributors All authors contributed to the conception and design of the work, the acquisition and interpretation of data. All authors have approved the final version of the manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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