Canadian C-Spine Rule
Info
Any high-risk factors which mandates radiography? Yes No -
~ - Age >= 65 years
~ - Dangerous mechanism
~ - Fall from an elevation >=3 ft or 5 stairs
~ - Axial load to the head (e.g., diving)
~ - Motor vehicle collision (MVC) at high speed (>100 km/hr) or with rollover or ejection
~ - Collision involving a motorized recreational vehicle; or a bicycle collision
~ - Paraesthesia in any extremity
Any low-risk factor which allows safe assessment of range of motion? Yes No -
~ - Simple rear-end road motor vehicle collision (MVC)** OR
~ - Pushed into oncoming traffic
~ - Hit by a bus or a large truck
~ - Rollover
~ - Hit by a high-speed vehicle
~ - Sitting position in ED OR
~ - Ambulatory at any time OR
~ - Delayed (not immediate) onset of neck pain after trauma OR
~ - Absence of midline cervical spine tenderness
Able to actively rotate neck? Yes No -
~ - 45° left and right
R e s u l t s
~ - Age >= 65 years
 
~ - Dangerous mechanism
 
~ - Fall from an elevation >=3 ft or 5 stairs
 
~ - Axial load to the head (e.g., diving)
 
~ - Motor vehicle collision (MVC) at high speed (>100 km/hr) or with rollover or ejection
 
~ - Collision involving a motorized recreational vehicle; or a bicycle collision
 
~ - Paraesthesia in any extremity
 
~ - Simple rear-end road motor vehicle collision (MVC)** OR
 
~ - Pushed into oncoming traffic
 
~ - Hit by a bus or a large truck
 
~ - Rollover
 
~ - Hit by a high-speed vehicle
 
~ - Sitting position in ED OR
 
~ - Ambulatory at any time OR
 
~ - Delayed (not immediate) onset of neck pain after trauma OR
 
~ - Absence of midline cervical spine tenderness
 
~ - 45° left and right
 
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Info
Canadian C-Spine Rule

The C-Spine Rule is a high sensitive clinical decision rule for C-spine radiography in trauma patients whare stable and alert (Glasgow Coma Scale = 15).

The objective of this decision tool is trecognize imaging requirement for evaluation of cervical spine fractures in trauma patients.

The questionnaire utilized in this calculation includes:

  1. Any high-risk fators which mandates radiography
    • Age >=65 years OR
    • Dangerous Mechanism OR
      • Fall from an elevation >=3 ft or 5 stairs
      • Axial load tthe head (e.g., diving)
      • Motor vehicle collision (MVC) at high speed (>100 km/hr) or with rollover or ejection
      • Collision involving a motorized recreational vehicle; or a bicycle collision
    • Parasthesias in extremities
  2. Any low risk factor which allows safe assessment of range of motion
    • Simple rearend MVC OR
      • Pushed intoncoming traffic
      • Hit by a bus or a large truck
      • Rollover
      • Hit by a high-speed vehicle
    • Sitting position in ED OR
    • Ambulatory at any time OR
    • Delayed (not immediate) onset of neck pain after trauma OR
    • Absence of midline cervical spine tenderness
  3. Able tactively rotate neck?
    • 45° left and right

Abbreviations used:

  • GCS = Glasgow Coma Scale
  • MCV = Motor vehicle collision
  • ED = Emergency Department

Interpretation

The user needs to select Yes or No for the appropriate questions in the correct order which is then used tindicate the result, i.e, Radiography or No Radiography

References:

Canadian CT Head and C-Spine (CCC) Study Group. Canadian C-Spine Rule study for alert and stable trauma patients: I. Background and rationale. CJEM. 2002;4(2):84-90.

Stiell IG, Wells GA, Vandemheen KL, et al. The Canadian C-spine rule for radiography in alert and stable trauma patients. JAMA. 2001;286(15):1841-8.