Canadian C-Spine Rule
- Canadian C-Spine Rule
- Canadian Cervical Spine Rule
- 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
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)
- See: Neck Pain Main
- Stiell et al
- Sensitivity: 99.4
- Specificity: 45.1
- Image courtesy of canadianem.org, "Canadian C-spine Rule Mnemonic"
- Stiell IG et al. The Candian C-Spine Rule versus the NEXUS Low-Risk Criteria in patients with trauma. N Engl J Med 2003;349:2510-8.