Canadian C-spine Rules
The Canadian C-spine Rule (CCR) was developed to help clinicians determine which trauma patients need c-spine imaging.
It is highly sensitive for CSI (cervical spine injury), with the majority of studies finding it catches 99-100% of these types of injuries.
CCR would allow healthcare providers to safely decrease the need for imaging among this patient population by over 40%.
Subsequent studies have found a sensitivity of 90-100% for CSI with majority finding 99-100% sensitivity.
Unstable Vital Signs
Age <16 Years
Known Vertebral Disease
Previous C-Spine Surgery
Stiell IG, Wells GA, Vandemheen KL, Clement CM, Lesiuk H, De Maio VJ, Laupacis A, Schull M, McKnight RD, Verbeek R, Brison R, Cass D, Dreyer J, Eisenhauer MA, Greenberg GH, MacPhail I, Morrison L, Reardon M, Worthington J. The Canadian C-spine rule for radiography in alert and stable trauma patients. JAMA. 2001 Oct 17;286(15):1841-8. PubMed PMID: 11597285
Stiell IG, Clement CM, Mcknight RD, et al. The Canadian C-spine rule versus the NEXUS low-risk criteria in patients with trauma. N Engl J Med. 2003;349(26):2510-8.
Stiell IG, Clement CM, Grimshaw J, et al. Implementation of the Canadian C-Spine Rule: A prospective 12 centre cluster randomised trial. BMJ. 2009;339:b4146.
Dickinson G, Stiell IG, Schull M, Brison R, Clement CM, Vandemheen KL, Cass D, McKnight D, Greenberg G, Worthington JR, Reardon M, Morrison L, Eisenhauer MA, Dreyer J, Wells GA. Retrospective application of the NEXUS low-risk criteria for cervical spine radiography in Canadian emergency departments. Ann Emerg Med. 2004 Apr;43(4):507-14. PubMed PMID: 15039695.
Stiell IG, Wells GA, Vandemheen K, et al. Variation in emergency department use of cervical spine radiography for alert, stable trauma patients. CMAJ. 1997;156(11):1537-44.