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
  • Patients were eligible for enrollment if they were at some risk for C-spine injury either because they had neck pain from any mechanism of injury, or because they had no neck pain but had all of the following: some visible injury above the clavicles, had not been ambulatory, and had sustained a dangerous mechanism of injury
  • 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
  • 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
  • Critical revision of the manuscript for important intellectual content: Stiell, Wells, Vandemheen, Clement, Lesiuk, De Maio, Laupacis, Schull, McKnight, Verbeek, Brison, Cass, Dreyer, Eisenhauer, Greenberg, MacPhail, Morrison, Reardon, Worthington

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