Canadian cervical spine rule: Difference between revisions

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==Rule==
==Rule==
=== If ANY High Risk factor present – then get an X-ray  ===
===Canadian C-Spine Rule===
*Age >65 years
====No High Risk Factors====
*Dangerous mechanism  
*Age >65
**fall from elevation ≥ 3 feet / 5 stairs
*Dangerous mechanism
**axial load to head, e.g. diving
*Parasthesias in extremities
**MVC high speed (>100km/hr), rollover, ejection
====ANY Low Risk Factor====
**motorized recreational vehicles
*Simple rear end MVC
**bicycle struck or collision
*Delayed onset of pain
*Parasthesia in extremities
*Sitting position in ED
*Ambulatory at any time
*Absence of midline C-spine tenderness
====ROM====
*Rotates neck 45 degrees to left and right


=== If ANY Low-Risk factor present – then assess clinically with ROM testing  ===
''C-spine can be cleared clinically if above criteria met''<ref> 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. </ref> <ref> 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. </ref>
(If the answer to any of these is NO then get an x-ray)  
 
*Simple rear-end MVC which DOES NOT include the following
**pushed into oncoming traffic
**hit by bus / large truck
**rollover
**hit by high speed vehicle
*Sitting in ED
*Ambulatory at anytime
*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  ==
== Canadian rule vs. Nexus  ==

Revision as of 23:10, 3 September 2015

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 C-Spine Rule

No High Risk Factors

  • Age >65
  • Dangerous mechanism
  • 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]

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

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.
  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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