The canadian c spine rule was validated with patients who. The canadian c spine rule is a highly sensitive decision rule for evaluate of clinically significant cervical spine injuries in trauma patients. The canadian cspine rule for imaging of the cervical spine was developed for use by physicians. Started in 1995, this collection now contains 6767 interlinked topic pages divided into a tree of 31 specialty books and 732 chapters.
Lowrisk criteria nlc are decision rules to guide the use of cervicalspine radiography in patients with trauma. Z any lowrisk factor which allows safe assessment of range of motion. Applying the canadian c spine rule would allow healthcare providers to safely decrease the need for imaging. 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. Canadian cspine rule for alert gcs15 and stable trauma patients where cervical spine injury is a concern. Anton, md paul bradford, md ed cain, md andrew travers, md, msc matt stempien, md martin lees, md doug munkley, md erica battram, rn jane banek, chim george a. Nov 18, 2017 c spine imaging is costly, time consuming for patients, and exposes them to radiation.
Cspine rule versus the nexus lowrisk criteria in patients with trauma. The canadian cspine rule ccr is a decision making tool used to determine when radiography should be utilized in patients following trauma. The canadian cspine rule for radiography in alert and stable. Wainner rs, fritz jm, irrgang jj, boninger ml, delitto a, allison s. Aug 10, 2010 the canadian c spine rule for imaging of the cervical spine was developed for use by physicians. 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. Multicentre prospective validation of use of the canadian c.
This page includes the following topics and synonyms. C spine rule laminate v7 copy ubc physical therapy programs. 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. Even though, nexus has been shown to be less sensitive than the ccr. Learn vocabulary, terms, and more with flashcards, games, and other study tools.
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. Canadian cspine rule ottawa hospital research institute. I argue that we should not send patients to imaging unless we have used the nexus rule and then added the canadian c spine rule to the sequence. Canadian cspine rule definition of canadian cspine rule. Canadian cspine rule study for alert and stable trauma patients. 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. Accuracy of the canadian cspine rule and nexus to screen for. The canadian cspine rule clinically clears cervical spine fracture without imaging.
Over the 24 month trial period, 148 doctors were provided training in the use. Apr 14, 2017 the goal of the canadian c spine rule is to rule out cervical spine fractures after blunt trauma to the head. If we could clear the c spine clinically using the history and exam, and this was a safe practice, it would be better than getting an xray or ct. We believe that nurses in the emergency department could use this rule to clinically clear the. 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. Methods the study was conducted in two uk emergency departments with a combined annual attendance of 150 000 adult patients. Apr 19, 2016 the anatomic c spine fulcrum in pediatric patients less than age 8 years is between c2c3 by age 8, the fulcrum moves down to c5c6, similar to adults there are other important differences between the pediatric c spine and the adult c spine. 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. The outofhospital validation of the canadian c spine rule by paramedics christian vaillancourt, md, msc ian g. Especially when compared to the simpler nexus spine rule, this cdr often has been noted by various people to be difficult to actually navigate. For many people, this has lead to barriers for adoption of the canadian c spine rules. Still always be careful not to induce unneeded fear into the patient but still absolutely worth knowing well.
We believe that nurses in the emergency department could use this rule to clinically clear the cervical spine. Ccr is highly sensitive for csi, with the majority of studies finding it catches 99100% of these types of injuries. The canadian cspine rule versus the nexus lowrisk criteria in patients with trauma. A clinical decision rule to determine the need for diagnostic imaging for alert and stable trauma patients gcs 15 with neck pain. The canadian cspine rule ccr is a decision making tool used to.
Ian stiell, professor in the department of emergency medicine at the university of ottawa, discussing the assessment of. Reliability and diagnostic accuracy of the clinical examination and patient selfreport measures for cervical radiculopathy. The canadian cspine rule for radiography in alert and stable trauma patients. A prediction rule consisting of a cluster of signs and symptoms that help to rule out the need for a radiograph to diagnose a spinal fracture in a patient who comes to the emergency department after receiving an injury to the head or neck. Faqs 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 canadian cspine rule ccr was developed to help physicians determine which trauma patients need cspine imaging. The ottawa rules are a set of clinical decision rules developed by dr. 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. Canadian cspine rule cervical spine fractures youtube. We prospectively evaluated the accuracy, reliability and acceptability of the canadian c spine rule when used by nurses. Improving mechanical neck pain starts with educating the patient about the favourable prognosis and increasing the range of neck movement. Kylie bosman discusses backboard and collar nightmares. Results for canadian c spine rules 1 10 of 162 sorted by relevance date.
Faqs the canadian c spine 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. Canadian c spine rule and the national emergency xradiography utilization study nexus for detecting clinically important cervical spine injury following blunt trauma. In this episode, i discuss the diagnosis of c spine injuries. In the first of our series on highlights from north york generals emergency medicine update conference, dr. Canadian c spine rule for alert gcs15 and stable trauma patients where cervical spine injury is a concern. The outofhospital validation of the canadian cspine rule. Consider obtaining a ct scan if any questions in the rule are answered affirmatively. Define whether any high risk factors are present such as age. Canadian cspine rule, canadian cervical spine rule. Although cervical spine trauma is more common following high velocity mechanisms of injury resulting in multiple injuries, falls and low velocity mechanisms may also result in serious cervical spine injury. For alert gcs15 and stable trauma patients where cervical spine injury is a concern. The goal of the canadian cspine rule is to rule out cervical spine fractures after blunt trauma to the head. Define low risk factors that allow safe assessment of neck rom.
Background 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 cervica. Age 65 years or dangerous mechanism or pa r esthesias in extremities 2. If this is the case, an xray of the cervical spine. Pdf canadian cspine rule and the national emergency x. There is increased elasticity of facet joint ligaments. Radiography utilization study nexus for detecting clinically important cervical spine. Accuracy of the canadian cspine rule and nexus to screen. Canadian cspine rule for clinical clearance journalfeed. Canadian cspine rule the ottawa hospital research institute. Any lowrisk factor which allows safe assessment of range of motion. Ian stiell and his research team at the ottawa hospital research institute and the university of ottawa. Canadian cspine rule archives emergency medicine cases. For alert glasgow coma scale 15 and stable trauma patients where cervical spine injury is a concern. Canadian cspine rule and the national emergency xradiography utilization study nexus for detecting clinically important cervical spine.
If i use this rule, will i miss a serious c spine injury. Stiell, md, msc tammy beaudoin, chim justin maloney, md andrew r. 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. The rules have been demonstrated to decrease unnecessary diagnostic imaging and emergency room wait times which enhances patient comfort and reduces health care costs. Click export csv or ris to download the entire page or use the checkboxes to select a. Age at least 65 years or dangerous mechanism1 or paresthesias in extremities no no yes yes able unable. 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.
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