The Canadian C-Spine Rule for Radiography in Alert and Stable Trauma Patients

We evaluated 25 primary predictor variables as well as another 8 created by combination or cutpoints

Ian G. Stiell

2003

Scholarcy highlights

  • ORE THAN 1 MILLION PAtients with blunt trauma and potential cervical spine injury are treated each year in US emergency departments. Among those patients presenting with intact neurological status, the incidence of acute fracture or spinal injury is less than 1%
  • “little ticket” item, a low-cost procedure that significantly adds to health care costs due to its high volumes of use
  • We developed a highly sensitive clinical decision rule that, if prospectively validated, will allow physicians to rationally order C-spine radiography for alert and stable trauma patients who are at risk for neck injury
  • A number of studies have been conducted in recent years by emergency physicians, trauma surgeons, and radiologists to identify a group of trauma patients who do not need C-spine radiography
  • We found that patients 65 years or older and those experiencing paresthesias were at considerable risk of C-spine injury, and that all such patients should undergo radiography
  • Our study has developed the highly sensitive Canadian Cervical Spine Rule to identify a large group of patients for whom C-spine radiography is unnecessary
  • There is considerable practice variation among well-trained emergency physicians, with radiography rates ranging as much as 6-fold. Cervical spine radiography is an example of a “little ticket” item, a low-cost procedure that significantly adds to health care costs due to its high volumes of use

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