Canadian C-Spine

What is it?

• Validated clinical decision-making rule for cervical spine clearance

• Determines the need for imaging following trauma

• Mostly used in ER/Hospital settings, but can be used as referral tool

• Screens for cervical vertebrae fracture

• High sensitivity test (90-100%)

  • Good at ruling conditions out

Structure

• Algorithm style

  • Exclusion criteria

  • 3 step algorithm

    • High risk factors

    • Low risk factors

    • ROM (Actively rotate neck)

High risk factors

• >= 65 yrs old

• Paresthesia of extremities

• Dangerous mechanism of injury

  • Fall from >= 3 ft

  • Axial load to head

  • High speed MVC, ejection or rollover

  • Motorized recreational vehicles

  • Bicycle struck or intense collision

Low risk factors

• Simple rear-end motor vehicle collision

• Sitting position in the emergency department/clinic

• Ambulatory at any time after the injury

• Delayed onset of neck pain

• Absence of midline cervical spine tenderness

ROM

• Are the able to…

  • Rotate head 45 degrees L & R? (AROM)

  • Do not apply overpressure in PROM

Exclusion criteria

• Rule not applicable if:

  • Non trauma cases

  • Glasgow coma scale <15

  • <= 16 yrs old

  • Acute paralysis

  • Known vertebral disease

  • Previous cervical spine injury

  • Pregnant

• Why is this important?

  • Keeps high sensitivity by working within specific populations

  • Avoids false positives from previous injury or other conditions

  • Pt is alert and can answer the questions