Validity and reliability of clinical prediction rules used to screen for cervical spine injury in alert low-risk patients with blunt trauma to the neck: part 2. A systematic review from the Cervical Assessment and Diagnosis Research Evaluation (CADRE) Collaboration.

PURPOSE: To update findings of the 2000-2010 Bone and Joint Decade Task Force on Neck Pain and its Associated Disorders (Neck Pain Task Force) on the validity and reliability of clinical prediction rules used to screen for cervical spine injury in alert low-risk adult patients with blunt trauma to the neck. METHODS: We searched four databases from 2005 to 2015. Pairs of independent reviewers critically appraised eligible studies using the modified QUADAS-2 and QAREL criteria. We synthesized low risk of bias studies following best evidence synthesis principles. RESULTS: We screened 679 citations; five had a low risk of bias and were included in our synthesis. The sensitivity of the Canadian C-spine rule ranged from 0.90 to 1.00 with negative predictive values ranging from 99 to 100%. Inter-rater reliability of the Canadian C-spine rule varied from k = 0.60 between nurses and physicians to k = 0.93 among paramedics. The inter-rater reliability of the Nexus Low-Risk Criteria was k = 0.53 between resident physicians and faculty physicians. CONCLUSIONS: Our review adds new evidence to the Neck Pain Task Force and supports the use of clinical prediction rules in emergency care settings to screen for cervical spine injury in alert low-risk adult patients with blunt trauma to the neck. The Canadian C-spine rule consistently demonstrated excellent sensitivity and negative predictive values. Our review, however, suggests that the reproducibility of the clinical predictions rules varies depending on the examiners level of training and experience.

[Prevention as a pension insurance task: innovative models complementing proven concepts]. / Prävention als Aufgabe der Rentenversicherung: Innovative Modelle ergänzen bewährte Konzepte.

Health-related strategies aimed at ensuring long-term participation in working life are gaining increasing importance against a background of longer working lives and demographic change. Medical and vocational rehabilitation under the German statutory pension insurance scheme are among these strategies. For a long time already, preventive concepts have been taken into account in rehabilitation so that the pension insurance's prevention approach is mainly based on the experience gained with preventive-modules in rehabilitation and follow-up care. Having so far only been able to offer in-patient prevention benefits, the statutory pension insurance scheme now can offer out-patient prevention measures, given the amendment it initiated to change Section 31 (1) no. 2 of Book 6 of the German Social Code which came into effect on January 1, 2009. The common guidelines of the statutory pension insurance institutions directed at ensuring continued working capacity were revised relative to the preventive benefits contained and were supplemented by recommendations for their use. The changing occupational demands in modern service society have thus been taken into account, and prevention benefits can be implemented in a more flexible manner following successful trials. The concept of out-patient prevention measures following along at the workplace and during leisure time is intended to enhance sustainability of acquired health-promoting behaviours in every day (working) life. At present this new concept is being tried out in various circumscribed pilot projects by several pension insurance institutions, partly in combination with in-patient components. On account of their specific know-how and their regional networks with enterprises, rehabilitation facilities are destined as locations for carrying out pension insurance prevention benefits.