Canadian C-Spine Rule

Other Names

• Canadian C-Spine Rule
• Canadian Cervical Spine Rule

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Purpose

• Decision making tool for radiographic evaluation of the cervical spine following trauma
• Generally speaking, the application of this tool requires a patient to be clinically stable with a GCS of 15

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Description

Canadian C-spine rules

1) Any high risk factors which mandate radiography?

• Age greater than 65
• Dangerous Mechanism
  • Fall from elevation >3 feet or 5 stairs
  • Axial load to head
  • MVC speed >100 km/hr, rollover or ejection
  • Motorized Recreational vehicles
  • Bicycle struck or collision
• Parasthesias in extremities

2) Any low row risk factor which allows safe assessment of range of motion?

• Simple rear-end motor vehicle collision (MVC)
  • Excludes: Pushed into oncoming traffic, hit by bus or large truck, rollover, hit by high speed vehicle
• Sitting position in emergency department
• ambulatory at any time
• delayed onset of neck pain (not immediate onset)
• absence of midline C spine tenderness

3) Able to actively rotate neck?

• 45° left and right

4) Imaging Indicated

• Yes to question 1 (high risk features)
• No to question 2 (low risk features)
• Inability to range neck (unstable)

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Pathology

• See: Neck Pain Main

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Evidence

• Stiell et al
  • Sensitivity: 99.4
  • Specificity: 45.1

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See Also

• Neck Pain Main
• Physical Exam Neck

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