From the Research
The CiNA score is a clinical decision tool that combines the Canadian C-Spine Rule and the National Emergency X-Radiography Utilization Study (NEXUS) criteria to help clinicians determine whether cervical spine imaging is necessary in trauma patients. This tool is designed to safely reduce unnecessary radiographic imaging while ensuring that clinically significant cervical spine injuries are not missed. The Canadian C-Spine Rule assesses high-risk factors (age ≥65, dangerous mechanism of injury, or paresthesias in extremities), low-risk factors that allow safe assessment of range of motion (simple rear-end motor vehicle collision, sitting position in the emergency department, ambulatory at any time, delayed onset of neck pain, or absence of midline cervical tenderness), and the ability to rotate the neck 45 degrees left and right. The NEXUS criteria include absence of midline cervical tenderness, no focal neurologic deficit, normal alertness, no intoxication, and no painful distracting injury. By combining these validated approaches, the CiNA score provides clinicians with a comprehensive framework to make evidence-based decisions about cervical spine imaging in trauma settings, balancing the need to identify serious injuries with the goal of avoiding unnecessary radiation exposure and healthcare costs, as supported by studies such as 1.
Some key points to consider when using the CiNA score include:
- The Canadian C-Spine Rule has been shown to be highly sensitive for detecting acute C-spine injury, with a sensitivity of 100% and a specificity of 42.5% in one study 1.
- The NEXUS criteria have also been validated as a tool for determining the need for cervical spine imaging, with a high sensitivity and specificity for detecting clinically significant cervical spine injuries.
- The CiNA score can help reduce unnecessary radiographic imaging, which can decrease radiation exposure and healthcare costs, while also ensuring that clinically significant injuries are not missed.
- The use of the CiNA score requires careful consideration of the patient's clinical presentation and mechanism of injury, as well as their ability to rotate their neck and absence of midline cervical tenderness.
Overall, the CiNA score is a useful tool for clinicians to make evidence-based decisions about cervical spine imaging in trauma patients, and its use can help improve patient outcomes while reducing unnecessary radiation exposure and healthcare costs, as supported by studies such as 1.