EBQ:Canadian C-spine Rule Study

incomplete Journal Club Article

Stiell, Ian et al. "The Canadian C-spine Rule for Radiography in Alert and Stable Trauma Patients". JAMA. 2001. 286(15):1841-1848.
PubMed Full text PDF

Clinical Question

Can a clinical decision rule be used to evaluate the cervical spine in alert and stable trauma patients?

Conclusion

The Canadian C-spine rule is a highly sensitive decision rule for evaluate of clinically significant cervical spine injuries in trauma patients.

Major Points

Three Main Questions:

1. Is there any high-risk factor that mandates radiography?
2. Is there any low-risk factor that allows safe assessment of ROM?
3. Is pt able to actively rotate neck 45° to the left and right?

Study Design

Prospective cohort study of blunt trauma patients from 10 Canadian EDs (community and university hospitals), where each pt was evaluated for 20 standardized clinical findings before radiographs. Subset of patients were assessed by second EM physician independently. Additional 5 demographic variables obtained by study RNs from hospital records.

Inclusion Criteria

• Patients sustaining acute blunt trauma to head/neck, who were at risk for C-spine injury, which is defined as the following:
  • Neck pain based on mechanism of injury
  • No neck pain w/ some visible injury above clavicles, non-ambulatory before, and sustained dangerous mechanism
• Patient had to be alert (GCS 15) and stable (nl VS = SBP>90 and RR 10-24/min)

Exclusion Criteria

• Age <16 years old
• Minor injuries (ie simple laceration) and did not meet inclusion criteria
• GCS<15
• Grossly abnl VS
• Injured >48hrs previously
• Penetrating trauma
• Acute paralysis
• Known vertebral disease (ie RA, spine stenosis, previous C-spine injury, anklyosing spondylitis)
• Returned for reassessment of same injury
• Pregnant

CME

Neuro/trauma question: The following patients are brought in to the ED with C-Collars in place. Which patient/patients, if any, could have their cervical spines cleared clinically and removed from immobilization? (more than one answer

	9 year old female with unwitnessed fall from bed on to carpeted floor with no loss of consciousness or neck pain, ambulating on scene upon paramedic arrival and only complains of an abrasion to his elbow and tingling/pins and needles sensation in her hand
	47 year old male who was assaulted with loss of consciousness, now 4-6-5, with no other injury/deficits.
	18 year old male who is A+O x3 with facial abrasions but with no neurological deficits, loss of consciousness or neck pain brought in after an MVA in which his main injury is an open femur fracture
	27 your old female found down outside of a bar GCS 4-6-4 initially upon paramedic arrival now 4-6-5 with positive ETOH on breath, who admits to having just a couple of beers earlier in the evening
	95 year old woman who sustained a mechanical fall in bathtub. No midline neck pain, denies A+O x3, no other complaints/injuries, normal neuro exam. Only complaint is a 2cm laceration to her eyebrow.