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Canadian C-Spine Rules

1. Any high-risk factor which mandates radiography ?
Age >65 years or Dangerous mechanism ^* or Paresthesias in extremities

2. Any low risk factor which allows safe assessment of range of motion?
Simple rearend MVC ^ or Sitting position in ED or Ambulatory at any time or Delayed onset of neck pain ^* or Absence of midline C-spine tenderness		Radiography: 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

^***Delayed
- i.e. not immediate onset of neckpain

Ability to detect clinical significant C-spine injury: Sensitivity: 99,4% - Specificity 45.1%

Referenties

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.