1. NEXUS Assessing the Cervical Spine National Emergency X-Radiography Utilisation Study Safe management of the cervical spine injury without an xray.

2. CRITERIA Focal Neurological deficit Midline spinal tenderness is present Altered level of consciousness present Distracting injury present Intoxication

3. Sensitivity/Specificity The NEXUS Criteria were developed to help physicians determine whether cervical spine imagine could be safely avoided in appropriate patients. Validation study included a prospective, observational sample of 34,069 patients, aged 1 to 101 years, presenting to 21 US trauma centers. 1.7% of those studied had clinically significant c-spine injuries (CSI). NEXUS Criteria found to have sensitivity of 99.6% for ruling out CSI (2/578). Also detected 99.0% (8/818) of ALL c-spine injuries (6 of which were injuries that didn’t require stabilization or specialized treatment).

4. Pitch side Assessment

5. DR ABCD DANGER RESPONSE AIRWAY BREATHING CIRCULATION DISABILITY

6. Clearing C-Spine Pitch side Neurology-symptoms Neck Pain Tenderness Pain free Movement-Lateral rotation This assessment assumes consciousness and no distracting injury

7. How Dangerous are Sports? Contact sports Table 5: Incidence of catastrophic injuries in a range of contact sports in Australia over the period 1984 to 2002 (injuries/100,000 participants per year). Rugby league Australia 1984 - 1996 Spinal 1.8 1986 - 1996 Spinal 2.4 1997 - 2002 Spinal 1.5 Australian Rules Australia 1986 - 1996 Spinal 0.34 1997 - 2002 Spinal 0.52 Soccer Australia 1986 - 1996 Spinal 0.03 1997 - 2002 Spinal 0.19

9. Non-contact sports: Incidence of fatal and serious injuries in a range of sports in Australia over the period 2001 to 2003 (injuries/100,000 participants per year). Sport Incidence of injury Horse riding 29.7 Motor sport 113.3 Rock climbing 6.6 Snow skiing 2.5 Swimming 1.8 Australian Rules Football 5.5

11. CONTEXT The risk of catastrophic injury from rugby union in England is comparable with that experienced by most of the population in work-related situations (average: 0.8/100,000 per year) but much less than that experienced by car occupants (2.9/100,000 per year), pedestrians (3.7/100,000 per year) and motorcyclists (190/100,000 per year). The risk of sustaining a catastrophic injury in rugby union is an order of magnitude lower than the risk of death experienced by women during pregnancy (12/100,000 per year).