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Cervical Pain Appropriate Use Criteria

UC Cervical Pain AUC Criteria (pdf)

Priority Clinical Area Coverage

This AUC reasonably addresses common and important clinical scenarios within the "Cervical or neck pain" Priority Clinical Area (PCA) and thus meets the minimum requirement for qCDSM to cover that PCA. However, by CMS definition of relevancy, it is not considered relevant to that PCA, as further described (See AUC Overview).

Search Strategy and Sources - Completed 2023-04-25

  • Limits:  English, 15 years publication, and adult, 19+
  • Extensive PubMed (Medline), Supplemental: EMBase, Web of Science, and Cochrane Database of Systematic Review

( ( (cervical vertebrae/di,dg  OR neck Injuries/di,dg OR neck pain/di,dg) major ] Or[ (cervical vertebrae OR neck Injuries OR neck pain) major AND diagnostic imaging (major) ) )

 AND

( decision support techniques OR sensitivity and specificity OR predictive value of tests OR emergency medical/standards OR evidence based medicine OR evidence based practice OR practice guidelines as topic OR investigative techniques (major) )

Di,dg = diagnosis OR diagnostic imaging

Results:

Using broader strategies by taking off the major designation and using combinations of cervical vertebrae injuries, neck injuries, spinal cord injuries, chronic pain and radiculopathy substantially increase retrieval.

The relevance levels per set are low, but it seems each strategic approach does come up several references that look interesting. It’s just the nature of the fuzzy aspect of AUC!  The only way to approach this is to search broad and then review it all!

Accordingly, the first round of searching resulted in 49 references culled from around 600 references. After the team leader’s review a second round of searching produced 130 references culled from approximately 1000 references.  Ultimately 32 references were selected for grading. 9 were selected for the AUC.

Cervical Pain AUC References and OCEBM Evidence Level:

  1. Bandiera, G., et al., The Canadian C-spine rule performs better than unstructured physician judgment. Ann Emerg Med, 2003. 42(3): p. 395-402. Level 2
  2. Coffey, F., et al., Validation of the Canadian c-spine rule in the UK emergency department setting. Emerg Med J, 2011. 28(10): p. 873-6. Level 2
  3. Denver, D., A. Shetty, and D. Unwin, Falls and Implementation of NEXUS in the Elderly (The FINE Study). J Emerg Med, 2015. 49(3): p. 294-300. Level 2
  4. Maung, A.A., et al., Cervical spine MRI in patients with negative CT: A prospective, multicenter study of the Research Consortium of New England Centers for Trauma (ReCONECT). J Trauma Acute Care Surg, 2017. 82(2): p. 263-269. Level 2
  5. Michaleff, Z.A., et al., Accuracy of the Canadian C-spine rule and NEXUS to screen for clinically important cervical spine injury in patients following blunt trauma: a systematic review. Cmaj, 2012. 184(16): p. E867-76. Level 2
  6. Morrison, J. and R. Jeanmonod, Imaging in the NEXUS-negative patient: when we break the rule. Am J Emerg Med, 2014. 32(1): p. 67-70. Level 2
  7. Pinheiro, D.F., et al., Diagnostic value of tomography of the cervical spine in victims of blunt trauma. Rev Col Bras Cir, 2011. 38(5): p. 299-303. Level 2
  8. Resnick, S., et al., Clinical relevance of magnetic resonance imaging in cervical spine clearance: a prospective study. JAMA Surg, 2014. 149(9): p. 934-9. Level 2
  9. Stiell, I.G., et al., Implementation of the Canadian C-Spine Rule: prospective 12 centre cluster randomised trial. Bmj, 2009. 339: p. b4146. Level 1