Canadian cervical spine rule

Canadian C-spine Rule

Only applies to GCS=15 and stable trauma. Not applicable for non-trauma, GCS<15, Hemodynamically unstable, Age <16, Acute paralysis, previous spinal disease or surgery.

If ANY High Risk factor present – then get an X-ray

1. Age >65 years
2. Dangerous mechanism
   1. fall from elevation ≥ 3 feet / 5 stairs
   2. axial load to head, e.g. diving
   3. MVC high speed (>100km/hr), rollover, ejection
   4. motorized recreational vehicles
   5. bicycle struck or collision
3. 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)

1. Simple rear-end MVC which DOES NOT include the following
   1. pushed into oncoming traffic
   2. hit by bus / large truck
   3. rollover
   4. hit by high speed vehicle
2. Sitting in ED
3. Ambulatory at anytime
4. Delayed onset of neck pain
5. Absence midline c-spine tenderness
6. Clinically evaluable (no intoxication, not altered, etc.)
7. Patient does not have any distracting injuries

Able to actively rotate neck?

1. 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

• C-Spine X-Ray
• C-Spine (NEXUS)

Source

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