Canadian C-Spine Rules

>Trauma Surgery >Canadian C-Spine RulesAuthor: J. Sprakel, MD - Latest update: 13-02-2015

Canadian C-Spine Rules

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Canadian C-Spine Rules

1. Any high-risk factor which mandates radiography ?
Age >65 years
Dangerous mechanism *
Paresthesias in extremities
2. Any low risk factor which allows safe assessment of range of motion?
Simple rearend MVC **
Sitting position in ED
Ambulatory at any time
Delayed onset of neck pain ***
Absence of midline C-spine tenderness
CT-cervical spine
3. Able to actively rotate neck?
No radiography
Send patient home

* Dangerous mechanism:
- Fall from elevation > 3 feet / 5 stairs
- Axial load to head, e.g. diving
- MVC high speed (>100 km/h), rollover, ejection
- Motorized recreational vehicles
- Bicycle collision
** Simple reareend MVC excludes:
- Pushed into oncoming traffic
- Hit by bus / large truck
- Rollover
- Hit by high speed vehicle
- i.e. not immediate onset of neckpain

Ability to detect clinical significant C-spine injury: Sensitivity: 99,4% - Specificity 45.1%
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1. Stiell IG, Clement CM, McKnight RD et al. The Canadian C-spine rule versus the NEXUS low-risk criteria in patients with trauma. N Engl J Med. 2003 Dec 25;349(26):2510-8.