Canadian cervical spine rule: Difference between revisions
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== Canadian C-spine Rule == | == Canadian C-spine Rule == | ||
Only applies to GCS=15 and stable trauma. Not applicable for non-trauma, GCS<15, Hemodynamically unstable, Age <16, Acute paralysis, previous spinal disease or surgery. | Only applies to GCS=15 and stable trauma. Not applicable for non-trauma, GCS<15, Hemodynamically unstable, Age <16, Acute paralysis, previous spinal disease or surgery. | ||
=== If ANY High Risk factor present – then get an X-ray === | === If ANY High Risk factor present – then get an X-ray === | ||
#Age >65 years | #Age >65 years | ||
#Dangerous mechanism | #Dangerous mechanism | ||
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=== If ANY Low-Risk factor present – then assess clinically with ROM testing === | === If ANY Low-Risk factor present – then assess clinically with ROM testing === | ||
(If the answer to any of these is NO then get an x-ray) | (If the answer to any of these is NO then get an x-ray) | ||
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=== Able to actively rotate neck? === | === Able to actively rotate neck? === | ||
#45 Degree Left and Right? If able then NO x-ray needed. If unable, get an x-ray. | #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 == | ||
=== Sensitivity === | === Sensitivity === | ||
Canadian 99.4% vs Nexus 90.7% | Canadian 99.4% vs Nexus 90.7% | ||
=== Specificity === | === Specificity === | ||
Canadian 45.1% vs. Nexus 36.8% | 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." | 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== | |||
*[[C-Spine X-Ray]] | |||
*[[C-Spine (NEXUS)]] | |||
== Source == | == Source == | ||
#N Engl J Med 2003; 349:2510-2518 | #N Engl J Med 2003; 349:2510-2518 | ||
#http://www.ohri.ca/emerg/cdr/cspine.html | #http://www.ohri.ca/emerg/cdr/cspine.html | ||
[[Category:Trauma]] [[Category:Ortho]] [[Category:Rads]] | [[Category:Trauma]] | ||
[[Category:Neuro]] | |||
[[Category:Ortho]] | |||
[[Category:Rads]] | |||
Revision as of 01:21, 18 December 2011
Canadian C-spine Rule
Only applies to GCS=15 and stable trauma. Not applicable for non-trauma, GCS<15, Hemodynamically unstable, Age <16, Acute paralysis, previous spinal disease or surgery.
If ANY High Risk factor present – then get an X-ray
- Age >65 years
- Dangerous mechanism
- fall from elevation ≥ 3 feet / 5 stairs
- axial load to head, e.g. diving
- MVC high speed (>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
(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
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
Source
- N Engl J Med 2003; 349:2510-2518
- http://www.ohri.ca/emerg/cdr/cspine.html