Orthopedics Book


Canadian C-Spine Rule

Aka: Canadian C-Spine Rule, Canadian Cervical Spine Rule
  1. See Also
    1. Cervical Spine Imaging in Acute Traumatic Injury
    2. NEXUS Criteria
    3. Cervical Spine CT
  2. Indications
    1. Cervical Spine Imaging in Acute Traumatic Injury
  3. Contraindications
    1. Canadian C-Spine Rule was not validated in children under age 16 years old or GCS of <15
  4. Criteria: High Risk Factors (increased probability of C-Spine Injury)
    1. Age over 65 years
    2. Fall from >3 feet (or 5 steps or 1 meter)
    3. Injury with axial load to head (e.g. spearing-type injury)
    4. High-speed motor vehicle accident (>62 MPH or >100 KPH)
    5. Motorized recreational vehicle injury
    6. Ejection from vehicle
    7. Bicycle collision with immovable object (e.g. tree, parked car)
    8. Extremity Paresthesias
  5. Criteria: Low Risk Factors (reassuring findings)
    1. Simple rear-end motor vehicle accident
    2. Patient sitting up in emergency department
    3. Patient ambulatory at any time after accident
    4. Delayed onset of Neck Pain
    5. Midline Cervical Spine pain absent
  6. Approach
    1. Step 1: Ask High Risk Criteria (increased probability of C-Spine Injury)
      1. Positive (1 or more high risk criteria): C-Spine Imaging Indicated
      2. Negative (no high risk criteria): Go to Step 2
    2. Step 2: Ask Low Risk Criteria (reassuring findings)
      1. Negative (no low risk criteria present): C-Spine Imaging Indicated
      2. Positive (1 or more low risk criteria): Go to Step 3
    3. Step 3: Assess Active Neck Range of Motion (neck rotation of 45 degrees in each direction)
      1. Patient can not rotate neck 45 degrees in either direction: C-Spine imaging indicated
      2. Patient can rotate neck fully: No imaging indicated
    4. Summary: C-Spine imaging is recommended if any of the following are present
      1. Any high risk criteria present or
      2. No low risk criteria (or reassuring findings present) or
      3. No high risk criteria AND positive low risk criteria AND UNABLE to actively rotate neck to either side >45 degrees
  7. Efficacy
    1. Test Sensitivity: 99.4-100%
    2. Test Specificity: 42.5-45%
    3. Negative Predictive Value: 100%
  8. References
    1. Stiell (2001) JAMA 286(15): 1841-8 [PubMed]
    2. Stiell (2003) N Engl J Med 349(26):2510-18 [PubMed]
    3. Vaillancourt (2009) Ann Emerg Med 54(5): 663-71 [PubMed]

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