Canadian cervical spine rule

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."

References

↑ 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.
↑ 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.

N Engl J Med 2003; 349:2510-2518
http://www.ohri.ca/emerg/cdr/cspine.html

Authors:

[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.

[1]

[2]