Canadian cervical spine rule: Difference between revisions

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==Background==
==Background==
Only applies to GCS=15 and stable [[blunt neck trauma]]. Not applicable for non-trauma, GCS<15, Hemodynamically unstable, Age <16, Acute paralysis, previous spinal disease or surgery.
*Only applies to [[Glasgow Coma Scale (GCS)|GCS]]=15 and stable [[blunt neck trauma]]
*Not applicable for:
**Non-trauma, GCS <15, Hemodynamically unstable, Age <16, Acute paralysis, previous spinal disease or surgery


==Rule==
==Rule==
=== If ANY High Risk factor present – then get an X-ray  ===
{{Template:C-spine Canadian}}
#Age &gt;65 years
#Dangerous mechanism
##fall from elevation ≥ 3 feet / 5 stairs
##axial load to head, e.g. diving
##MVC high speed (&gt;100km/hr), rollover, ejection
##motorized recreational vehicles
##bicycle struck or collision
#Parasthesia in extremities


=== If ANY Low-Risk factor present – then assess clinically with ROM testing  ===
==Mnemonic==
(If the answer to any of these is NO then get an x-ray)  
'''High Risk Rhyme'''
*Sixty five,
*Fast drive,
*Sense deprive
*(Image if alive)


#Simple rear-end MVC which DOES NOT include the following
'''Low Risk Rhyme'''
##pushed into oncoming traffic
*Slow wreck,
##hit by bus / large truck
*Slow neck,
##rollover
*Sitting down,
##hit by high speed vehicle
*Walking around,
#Sitting in ED
*C-spine fine
#Ambulatory at anytime
*(Range the spine)
#Delayed onset of neck pain
#Absence midline c-spine tenderness
 
=== Able to actively rotate neck?  ===
#45 Degree Left and Right? If able then NO x-ray needed. If unable, get an x-ray.
 
== Canadian rule vs. Nexus  ==
=== Sensitivity  ===
Canadian 99.4% vs Nexus 90.7%
 
=== Specificity  ===
Canadian 45.1% vs. Nexus 36.8%
 
Based on a prospective cohort trial Canadian rule "would have missed 1 patient and the [Nexus rule] would have missed 16 patients with important injuries."


==See Also==
==See Also==
*[[EBQ:Canadian C-spine Rule Study]]
*[[NEXUS cervical spine rule]]
*[[EBQ:NEXUS]]
*[[Blunt neck trauma]]
*[[Cervical spine clearance]]
*[[C-Spine X-Ray]]
*[[C-Spine X-Ray]]
*[[C-Spine (NEXUS)]]


== Source  ==
==External Links==
#N Engl J Med 2003; 349:2510-2518
*[http://www.mdcalc.com/canadian-c-spine-rule/ MDCalc Canadian C-Spine Rule]
#http://www.ohri.ca/emerg/cdr/cspine.html
*[http://www.mdcalc.com/nexus-criteria-for-c-spine-imaging/ MDCalc NEXUS]
 
==References==
<References/>


[[Category:Trauma]]  
[[Category:Trauma]]  
[[Category:Neuro]]
[[Category:Neurology]]
[[Category:Ortho]]  
[[Category:Orthopedics]]  
[[Category:Rads]]
[[Category:Radiology]]

Latest revision as of 14:16, 1 May 2017

Background

  • Only applies to GCS=15 and stable blunt neck trauma
  • Not applicable for:
    • Non-trauma, GCS <15, Hemodynamically unstable, Age <16, Acute paralysis, previous spinal disease or surgery

Rule

Canadian Cervical Spine Rule

Algorithm for evaluation of cervical spine injuries (Canadian C-spine Rule)

No High Risk Factors

  • Age >65
  • Dangerous mechanism (fall>3ft/5 stairs, high speed MVC (>60mph)/rollover/ejection, bicycle crash, RV, axial load injury)
  • Parasthesias in extremities

ANY Low Risk Factor

  • Simple rear end MVC
  • Delayed onset of pain
  • Sitting position in ED
  • Ambulatory at any time
  • Absence of midline C-spine tenderness

ROM

  • Rotates neck 45 degrees to left and right

C-spine can be cleared clinically if above criteria met[1] [2]

Mnemonic

High Risk Rhyme

  • Sixty five,
  • Fast drive,
  • Sense deprive
  • (Image if alive)

Low Risk Rhyme

  • Slow wreck,
  • Slow neck,
  • Sitting down,
  • Walking around,
  • C-spine fine
  • (Range the spine)

See Also

External Links

References

  1. ↑ Stiell IG,et al. The Canadian C-spine rule for radiography in alert and stable trauma patients. JAMA. 2001 Oct 17;286(15):1841-8. EBQ:Canadian C-spine Rule Study
  2. ↑ Stiell IG, et al. The Canadian C-spine rule versus the NEXUS low-risk criteria in patients with trauma. N Engl J Med. 2003;349(26):2510-8.
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