Canadian cervical spine rule
Revision as of 12:38, 3 September 2015 by Rossdonaldson1 (talk | contribs)
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
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
- EBQ:Canadian C-spine Rule Study
- C-Spine X-Ray
- NEXUS cervical spine rule
- C-Spine (EAST)
- Cervical spine clearance
References
- N Engl J Med 2003; 349:2510-2518
- http://www.ohri.ca/emerg/cdr/cspine.html