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Canadian C Spine Rule Decision Tool

  • Age in years
  • Any dangerous mechanism of injury
    Examples include fall from greater than or equal to 3 feet or 5 stairs or axial load to head or high speed motor vehicle collision or ejection or bicycle collision with immovable object
  • Extremity paresthesias
  • Any of these low risk factors present that allow safe assessment of range of motion
    Simple rear end motor vehicle collision
    Sitting position in emergency department
    Ambulatory at any time after injury
    Delayed onset of neck pain
  • Midline cervical spine tenderness present
  • Able to actively rotate neck 45 degrees left and right
  • Canadian C Spine Rule explanation and clinical context
    The Canadian C Spine Rule is a validated clinical decision rule intended for use in alert and stable adult trauma patients to determine the need for cervical spine imaging. The rule first checks for any high risk criteria including age greater than or equal to 65 years or dangerous mechanism of injury or presence of extremity paresthesia. If any high risk criterion is present imaging is recommended. If no high risk criterion is present the clinician assesses for any low risk factor that allows safe assessment of range of motion such as simple rear end motor vehicle collision or sitting position in the emergency department or ambulation at any time after the event or delayed onset of neck pain. If at least one low risk factor is present and there is no midline cervical spine tenderness then the clinician evaluates whether the patient can actively rotate the neck 45 degrees left and right. If the patient can perform this active rotation no imaging is recommended. If the patient cannot perform the rotation or if low risk factors are absent or midline tenderness is present imaging is recommended. This rule is applicable only to alert and stable trauma patients meeting original enrollment criteria and does not replace clinical judgment.

    Reference
    Stiell IG, Wells GA, Vandemheen K, et al. The Canadian C Spine Rule for Radiography in Alert and Stable Trauma Patients. JAMA. 2001;286:1841 to 1848.

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