Purpose: The Canadian Cervical Spine Rules were developed in order to determine the need for radiographs after acute head/neck injury secondary to the risk of fracture.
Rule:
High Risk Factors Present?
1. Age greater than 65
2. Dangerous Mechanism of Injury (i.e. fall greater than 1m or 5 stairs, axial load to head, high-speed motor vehicle accident, motorized recreational vehicle, bicycle collision)
3. Paresthesias in extremities
Low Risk Factors that allow safe assessment of range of motion?
1. Simple rear-end motor accident
2. Normal sitting posture in emergency department
3. Ambulatory at any time since injury
4. Delayed onset of neck pain and absence of midline tenderness
Is the patient able to actively rotate the neck greater than 45 degrees to the right and the left?
If there is (1) High Risk Factors or (2) Low Risk Factors and the inability to actively rotate the neck greater than 45 degrees to the right and the left, radiographs are indicated.
| Item | |
| SN | 0.90-1.00 |
| SP | 0.01-0.77 |
SN = sensitivity – ‘SnOut’ helps rule out a disease (higher number is better – >0.9 is excellent)
SP = Specificity – ‘SpIn’ helps rule in a disease (higher number is better – greater than 0.90 is excellent))
+LR = positive likelihood ratio – ratio of positive test results in a patients with the pathology (true positives) higher number is better (> 10 is excellent)
-LR = negative likelihood ratio – ratio of negative test results in a patients with the pathology (false negatives) lower number is better (< 0.1 is excellent)
PPV = positive predictive value – percentage of patients who both test positive & have the disease (true positives)
NPV = negative predictive value – percentage of patients who both test negative & do not have disease (true negatives)
References:
1. Coffey F, et al. Validation of the Canadian c-spine rule in the UK emergency department setting. Emerg Med J. 2011; 28(10):873-6.
2. Duane TM, et al. Canadian Cervical Spine rule compared with computed tomography: a prospective analysis. J Trauma. 2011; 71(2): 352-5.
3. Michaleff ZA, et al. Accuracy of the Canadian C-spine rule and NEXUS to screen for clinically important cervical spine injury in patients following blunt trauma: a systematic review. CMAJ. 2012; 84(16): E867-76.
4. Rethnam U, et al. Does applying the Canadian Cervical Spine rule reduce cervical spine radiography rates in alert patients with blunt trauma to the neck? A retrospective analysis. BMC Medical Imaging. 2008; 8:12.
5. Stiell IG, et al. Implementation of the Canadian C-Spine Rule: prospective 12 centre cluster randomised trial. BMJ. 2009; 339:b4146.
6. Stiell IG, et al. The Canadian C-spine rule for radiography in alert and stable trauma patients. JAMA. 2001; 286(15): 1841-8.
