The canadian cspine rule is a wellvalidated decision rule that can be used to safely rule out cervical spine injury csi in alert, stable trauma patients without the need to obtain radiographic images. It includes assessment for all gcs 15 patients age 65 with a dangerous mechanism or parenthesis in the. The canadian c spine cervical spine rule ccr and the national emergency xradiography utilization study nexus lowrisk criteria nlc are decision rules to guide the use of cervical spine. The guideline incorporates the validated canadian c spine rules. Pdf canadian cspine rule and the national emergency x. The canadian c spine rule ccr and the national emergency xradiography utilization study nexus low criteria are well accepted as guide to help physician in case of cervical blunt trauma. The canadian c spine rule for alert glasgow coma scale score 15 and stable trauma patients for whom cervical spine injury is a concern, including patients with either posterior neck pain with any blunt mechanism of injury or. Mar 29, 2018 healthcare professionals paramedics and trauma teams use the canadian c. Several studies suggest that c spine radiography may not have adequate sensitivity to rule out spine fracture, especially in the elderly. Pdf validation of the canadian cspine rule in the uk.
The canadian cspine rule was created in response to increased costs associated with nonessential radiography 98% and increased patient wait times while immobilized to back boards. The canadian cspine rule a clinical decision rule to determine the need for diagnostic imaging for alert and stable trauma patients gcs 15 with neck pain developed by dr. What are the canadian cspine rules ccr for cervical spine. In adult blunt trauma patients with concern for c spine injury, the canadian c spine rule ccr is an effective clinical tool to screen for those that would require imaging out of concern for clinically significant c spine injury sens 100%, npv 100%. Healthcare professionals paramedics and trauma teams use the canadian c.
The canadian c spine rules were published in 2001 stiell et. Any lowrisk factor which allows safe assessment of range of motion. If prospectively validated in other cohorts, this rule has the potential to significantly reduce practice variation and inefficiency in ed use of c spine. Canadian cspine rule for alert gcs15 and stable trauma patients where cervical spine injury is a concern. The canadian ct head and c spine ccc study is a large collaborative effort to develop clinical decision rules for the use of ct head in minor head injury and for the use of cervical spine radiography in alert and stable trauma victims.
Canadian cspine rule ottawa hospital research institute. The canadian cspine rule for radiography in alert and stable trauma patients. Dec 05, 2014 the canadian c spine rules ccr is an assessment tool used to rule out cervical spine injury in lowrisk patients, obviating the need for radiography. Part i details the background and rationale for the development of the canadian c spine rule. Application of the canadian cspine rule and nexus low. Cspine clearance using nexus vs canadian cspine rule in. The canadian cspine rule helps guide clinicians as to the indications for cervical xrays for alert and stable adults who have sustained recent blunt trauma and are at risk for clinically important cervical spine injury. The two commonly used clinical decision rules for clearance of the cervical spine are the canadian c spine rules ccr and nexus.
Validation of the canadian cspine rule in the uk emergency. The canadian c spine cervical spine rule ccr and the national emergency xradiography utilization study nexus lowrisk criteria nlc are decision rules to guide the use of cervical spine radiography in patients with trauma. The canadian c spine rule a clinical decision rule to determine the need for diagnostic imaging for alert and stable trauma patients gcs 15 with neck pain developed by dr. If this is the case, an xray of the cervical spine. Aim to determine the potential of the canadian cervical spine rule ccr to safely reduce the number of cervical spine c spine radiographs performed in the uk emergency department setting. It is not applicable in nontrauma cases, if the patient has unstable vital signs, acute paralysis, known vertebral disease or previous history of cervical spine surgery and age stable trauma patients gcs 15 with neck pain developed by dr. Canadian cspine rule and the national emergency xradiography utilization study nexus for detecting clinically important cervical spine. May 18, 2020 the canadian c spine rules ccr and the national emergency xradiography utilization group nexus criteria allow clinicians to clear lowrisk patients of c spine injury, obviating the need for.
The canadian cspine rule ccr is a decision making tool used to. For alert gcs15 and stable trauma patients where cervical spine injury is a concern. The canadian c spine rule ccr was developed to help physicians determine which trauma patients need c spine imaging. It is unclear how the two decision rules compare in terms of clinical performance. Only 905 children age canadian c spine rule can be used in the evaluation of all alert glasgow coma score of 15 and stable trauma patients where cervical spine injury is suspected and can help with clinical gestalt on whether radiographic images need to be obtained or not. Z any lowrisk factor which allows safe assessment of range of motion. Results of canadian c spine study z8924 patients enrolled z100 % sensitivity for identifying 151 clinically important c spine injuries z42. The canadian cspine cervicalspine rule ccr and the national emergency xradiography utilization study nexus lowrisk criteria nlc are decision rules to guide the use of cervicalspine. Still always be careful not to induce unneeded fear into the patient but still absolutely worth knowing well. Pdf on may 1, 2016, bruno tirotti saragiotto and others published the canadian cspine rule find, read and cite all the research you.
Prehospital implementation of the canadian cspine rule. Vaillancourt c, stiell ig, beaudoin t, maloney j, anton ar, bradford p, cain e, travers a, stempien m, lees m, munkley d, battram e, banek j, wells ga 2009 the outofhospital validation of the canadian c spine rule by paramedics. Pdf the use of the canadian cspine rule to reduce the. One study directly compared the accuracy of these 2 rules using the same cohort and found that the canadian c spine rule had better accuracy. Conclusion we have derived the canadian c spine rule, a highly sensitive decision rule for use of c spine radiography in alert and stable trauma patients. Unlike the canadian c spine rule ccr, nexus criteria does not have age cutoffs and is theoretically applicable to all patients 1 year of age. Consider obtaining a ct scan if any questions in the rule are answered affirmatively. The guideline incorporates the validated canadian cspine rules. The canadian cspine rule article pdf available in new england journal of medicine 35014.
Research implementation of the canadian c spine rule. Canadian cspine rule department of physical therapy. Trauma clinical guideline cervical spine injury evaluation. Prospective study 8900 patients in 10 canadian centres included. What are the canadian cspine rules ccr for cervical. Age 65 years or dangerous mechanism or pa r esthesias in extremities 2. Canadian c spine rules are a set of guidelines that help a clinician decide if cervical spine imaging is not appropriate for a trauma patient in the emergency department. Canadian c spine rule of the 9 studies that assessed the canadian c spine rule, 4 were prospective studies2,21,23 that aimed to assess the rule in its entirety. A recent clinical decision rule to identify lowrisk patients was accurate in distinguishing those who would not need radiography high sensitivity but would result in many patients being unnecessarily imaged low specificity. Over the 24 month trial period, 148 doctors were provided training in the use.
Overtesting for cervical spine injury is a widely acknowledged problem. The canadian c spine rule versus the nexus lowrisk criteria in patients with trauma. The canadian c spine rule 11, 12 the canadian c spine rules are designed for alert and stable trauma patients. Essentially, they state that the presence of any of a number of high risk factors age greater than 65, dangerous mechanism of injury, or paraesthesia in extremities mandates cervical spine radiology. The canadian cspine rule versus the nexus lowrisk criteria. The canadian cspine rule for radiography in alert and stable. How accurate is the canadian cspine rule for the detection. Two decision rules, the national emergency x radiography utilization study nexus low risk criteria nlc and the canadian c spine rule ccr, both published in 2001, were developed to reduce the unnecessary use of c spine radiography. Overview and comparison of nexus and canadian c spine rules difficult to determine exactly what type of injuries could interfere with a thorough physical exam or distract a patient from other injuries. For the canadian c spine rule, sensitivity ranged from 0.
The canadian c spine rule was developed from high quality research and found to be highly sensitive 98100%, reliable, clinically applicable, simple to use, and superior to both clinical judgement and similar decision rules. Faqs the canadian cspine rule helps guide clinicians as to the indications for cervical xrays for alert and stable adults who. The canadian cspine rule for imaging of the cervical spine was developed for use by physicians. Foerster skip to main content accessibility help we use cookies to distinguish you from other users and to provide you with a better experience on our websites. Wainner rs, fritz jm, irrgang jj, boninger ml, delitto a, allison s. The rules are derived from original research and incorporate three or more variables from the history, examination, or simple tests.
Radiography utilization study nexus for detecting clinically important cervical spine. The canadian c spine rule for radiography in alert and stable trauma patients. Canadian cspine rules are a set of guidelines that help a clinician decide if cervical spine imaging is not appropriate for a trauma patient in the emergency department. For alert glasgow coma scale 15 and stable trauma patients where cervical spine injury is a concern. While these rules are widely accepted, their current application and results are poorly studied. The canadian c spine rule ccr is a clinical decision or prediction rule developed in canada that is used to detect acute cervical spine injury. Applying the canadian c spine rule would allow healthcare providers to safely decrease the need for imaging. A clinical decision rule to determine the need for diagnostic imaging for alert and stable trauma patients gcs 15 with neck pain. The outofhospital validation of the canadian cspine. The canadian c spine rule ccr is a decision making tool used to determine when radiography should be utilized in patients following trauma. Canadian c spine rule for alert gcs15 and stable trauma patients where cervical spine injury is a concern.
The canadian head ct rule suggests a head ct is not necessary for this patient sensitivity 83100% for all intracranial traumatic findings, sensitivity 100% for findings requiring neurosurgical intervention. The canadian cspine rule ccr was developed to help physicians determine which trauma patients need cspine imaging. Oct 29, 2009 the rules are derived from original research and incorporate three or more variables from the history, examination, or simple tests. If prospectively validated in other cohorts, this rule has the potential to significantly reduce practice variation and inefficiency in ed use of c spine radiography.
Notable clinical prediction rules to determine which patients need medical imaging are canadian c spine rule and the national emergency xradiography utilization study nexus the following is based on the nexus national emergency xradiography utilization study criteria. Radiography utilization study nexus to screen for clinically important cervical spine injury csi in patients following blunt trauma. One of the two widely adopted and evidence based decision rules is used in the initial evaluation of the cervical spine following trauma. We believe that nurses in the emergency department could use this rule to clinically clear the. Notable clinical prediction rules to determine which patients need medical imaging are canadian c spine rule and the national emergency xradiography utilization study nexus. C spine rule laminate v7 copy ubc physical therapy programs.
Guidance accuracy of the canadian c spine rule and nexus to screen for clinically important cervical spine injury in patients following blunt trauma. Canadian cspine rules require validation and appropriate. The canadian c spine rule is applicable to patients who are in an alert glasgow coma scale score of 15 and stable condition following trauma where cervical spine injury is a concern. However, there is literature to suggest caution applying nexus to patients 65 years of age, as the sensitivity may be as low as 6684%. Reliability and diagnostic accuracy of the clinical examination and patient selfreport measures for cervical radiculopathy. To describe and compare the diagnostic accuracy of the canadian c. The canadian cspine rule for radiography in alert and. Define whether any high risk factors are present such as age. Validation of the canadian cspine rule in the uk emergency department setting article pdf available in emergency medicine journal 2810. The canadian cspine rule was developed from high quality research and found to be highly sensitive 98100%, reliable, clinically applicable, simple to use, and superior to both clinical judgement and similar decision rules. The canadian c spine rule performs better than unstructured physician judgment.
Methods the study was conducted in two uk emergency departments with a combined annual attendance of 150 000 adult patients. The canadian c spine rules ccr and the national emergency xradiography utilization group nexus criteria allow clinicians to clear lowrisk patients of c spine. A digital reference tool that contains the canadian c. Ccr is highly sensitive for csi, with the majority of studies finding it catches 99100% of these types of injuries. The canadian cspine rule is applicable to patients who are in an alert glasgow coma scale score of 15 and stable condition following trauma where cervical spine injury is a concern.