Online citations, reference lists, and bibliographies.

The Canadian C-spine Rule For Radiography In Alert And Stable Trauma Patients.

I. Stiell, G. Wells, K. Vandemheen, C. Clement, H. Lesiuk, V. D. De Maio, A. Laupacis, M. Schull, R. McKnight, R. Verbeek, R. Brison, D. Cass, J. Dreyer, M. Eisenhauer, G. Greenberg, I. MacPhail, L. Morrison, M. Reardon, J. Worthington
Published 2001 · Medicine

Cite This
Download PDF
Analyze on Scholarcy
CONTEXT High levels of variation and inefficiency exist in current clinical practice regarding use of cervical spine (C-spine) radiography in alert and stable trauma patients. OBJECTIVE To derive a clinical decision rule that is highly sensitive for detecting acute C-spine injury and will allow emergency department (ED) physicians to be more selective in use of radiography in alert and stable trauma patients. DESIGN Prospective cohort study conducted from October 1996 to April 1999, in which physicians evaluated patients for 20 standardized clinical findings prior to radiography. In some cases, a second physician performed independent interobserver assessments. SETTING Ten EDs in large Canadian community and university hospitals. PATIENTS Convenience sample of 8924 adults (mean age, 37 years) who presented to the ED with blunt trauma to the head/neck, stable vital signs, and a Glasgow Coma Scale score of 15. MAIN OUTCOME MEASURE Clinically important C-spine injury, evaluated by plain radiography, computed tomography, and a structured follow-up telephone interview. The clinical decision rule was derived using the kappa coefficient, logistic regression analysis, and chi(2) recursive partitioning techniques. RESULTS Among the study sample, 151 (1.7%) had important C-spine injury. The resultant model and final Canadian C-Spine Rule comprises 3 main questions: (1) is there any high-risk factor present that mandates radiography (ie, age >/=65 years, dangerous mechanism, or paresthesias in extremities)? (2) is there any low-risk factor present that allows safe assessment of range of motion (ie, simple rear-end motor vehicle collision, sitting position in ED, ambulatory at any time since injury, delayed onset of neck pain, or absence of midline C-spine tenderness)? and (3) is the patient able to actively rotate neck 45 degrees to the left and right? By cross-validation, this rule had 100% sensitivity (95% confidence interval [CI], 98%-100%) and 42.5% specificity (95% CI, 40%-44%) for identifying 151 clinically important C-spine injuries. The potential radiography ordering rate would be 58.2%. 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. 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.
This paper references
Posttraumatic neck pain: a prospective and follow-up study
RM McNamara (1988)
Evaluation of neck discomfort, neck tenderness, and neurologic deficits as indicators for radiography in blunt trauma victims.
R. Roberge (1992)
Roentgenographic evaluation of the cervical spine. A selective approach.
B. Roth (1994)
National Hospital Ambulatory Medical Care Survey: 1996 emergency department summary.
McCaig Lf (1994)
Prospective analysis of acute cervical spine injury: a methodology to predict injury.
L. Jacobs (1986)
Asymptomatic occult cervical spine fracture: case report and review of the literature.
T. McKee (1990)
Application of the Nexus Low-Risk Criteria for cervical spine radiography in Canadian emergency departments [abstract 417
IG Stiell (2000)
Variation in emergency department use of cervical spine radiography for alert, stable trauma patients.
I. Stiell (1997)
Cervical spine injury and radiography in alert, high-risk patients.
R. M. Mcnamara (1990)
Reprinted) ©2001 American Medical Association. All rights reserved
Cervical Spine Radiography (2001)
Emergency medicine: A comprehensive study guide (4th ed)
E. J. Otten (1996)
The jackknife, the bootstrap, and other resampling plans
B. Efron (1987)
Head injury and facial injury: is there an increased risk of cervical spine injury?
M. W. Hills (1992)
Clinical indications for cervical spine radiographs in the traumatized patient.
B. Bachulis (1987)
National Hospital Ambulatory Medical Care Survey: 1992 Emergency Department Summary.
S. Schappert (1997)
RECPAM: a computer program for recursive partition and amalgamation for censored survival data and other situations frequently occurring in biostatistics. I. Methods and program features.
A. Ciampi (1988)
Clinimetrics. New Haven, Conn: Yale
AR Feinstein (1987)
Evaluation of the cervical spine in the emergency setting: who does not need an X-ray?
T. Diliberti (1992)
Selective application of cervical spine radiography in alert victims of blunt trauma: A prospective study
Riemke M Brakema (1989)
Methodologic standards for the development of clinical decision rules in emergency medicine.
I. Stiell (1999)
Clinical prediction rules. Applications and methodological standards.
J. Wasson (1985)
Emergency medicine : concepts and clinical practice
P. Rosen (1983)
Cervical radiographic evaluation of alert patients following blunt trauma.
R. Fischer (1984)
Emergency Medicine: A Comprehensive Study Guide
J. Tintinalli (1996)
Clinical prediction rules. A review and suggested modifications of methodological standards.
A. Laupacis (1997)
Medical technology -- a different view of the contentious debate over costs.
T. Moloney (1979)
Obtaining consensus for a definition of “Clinically Important Cervical Spine Injury” in the CCC Study [abstract 196
IG Stiell (1999)
Correction: Validity of a Set of Clinical Criteria to Rule out Injury to the Cervical Spine in Patients with Blunt Trauma.
J. Offman (2001)
Clinical biostatistics: LIV. The biostatistics of concordance
M. Kramer (1981)
Emergency physicians' attitudes toward and use of clinical decision rules for radiography.
I. Graham (1998)
Incidence of cervical spine injuries in association with blunt head trauma.
P. Bayless (1989)
Prospective validation of prehospital spinal clearance criteria [abstract 053
RM Domeier (1995)
Cervical injury in head trauma.
G. L. Neifeld (1988)
Intracranial hemorrhage as a predictor of occult cervical-spine fracture.
G. Frye (1994)
Selective application of cervical spine radiography in alert victims of blunt trauma: a prospective study.
A. Sumchai (1988)
Role of routine emergency cervical radiography in head trauma.
G. Gbaanador (1986)
Prospective validation of a decision rule for the use of radiography in acute knee injuries.
I. Stiell (1996)
Cervical spine films, cost, and algorithms
D. Changaris (1987)
Facilitating cervical spine radiography in blunt trauma
Roberge Rj (1991)
Validity evaluation of the cervical spine injury proxy outcome assessment tool in the CCC Study [abstract 195
IG Stiell (1999)
Facilitating cervical spine radiography in blunt trauma.
R. Roberge (1991)
Etiology and clinical course of missed spine fractures.
D. Reid (1987)
Head, facial, and clavicular trauma as a predictor of cervical-spine injury.
J. Williams (1992)
Evaluation of neck discomfort, neck tenderness, and neurologic deficits as indicators for radiography in blunt trauma victims: Roberge RJ, Wears RC J Emerg Med 10:539–544 Oct 1992
T. A. Stephens (1993)
Limitations of cervical radiography in the evaluation of acute cervical trauma.
M. Solis (1994)
Cost containment and the physician.
T. Nesbitt (1978)
A Recursive Partitioning Decision Rule for Nonparametric Classification
J. Friedman (1977)
Radiology of the cervical spine in trauma patients: practice pitfalls and recommendations for improving efficiency and communication.
R. Vandemark (1990)
Multicentre trial to introduce the Ottawa ankle rules for use of radiography in acute ankle injuries
I. Stiell (1995)
Validity of a set of clinical criteria to rule out injury to the cervical spine in patients with blunt trauma.
Joakim Bjorkdahl (2001)
Emergency physicians’ views on the use of computed tomography and cervical spine radiography
ID Graham (1998)
Selective cervical spine radiography in blunt trauma: methodology of the National Emergency X-Radiography Utilization Study (NEXUS).
J. Hoffman (1998)
Post-traumatic neck pain: a prospective and follow-up study.
R. M. Mcnamara (1988)
The measurement of observer agreement for categorical data.
J. Landis (1977)
The etiology of missed cervical spine injuries.
J. Davis (1993)
Cervical radiography in the emergency department: who, when, how extensive?
R. Daffner (1993)
Implementation of the Ottawa Knee Rule for the use of radiography in acute knee injuries.
I. Stiell (1997)
Users' guides to the medical literature: XXII: how to use articles about clinical decision rules. Evidence-Based Medicine Working Group.
T. McGinn (2000)
Implementation of the Ottawa ankle rules.
I. Stiell (1994)
Low-risk criteria for cervical-spine radiography in blunt trauma: a prospective study.
J. Hoffman (1992)
Multicentre Ankle Rule Study Group. A multicentre trial to introduce the Ottawa ankle rules for the use of radiography in acute ankle injuries
IG Stiell (1995)

This paper is referenced by
Prescriptive Clinical Prediction Rules in Back Pain Research: A Systematic Review
S. May (2009)
Role of multidetector computed tomography in the assessment of cervical spine trauma.
A. González-Beicos (2009)
Complications from pre-hospital immobilisation
David S. Biller (2012)
Use of diagnostic imaging in the emergency department for cervical spine injuries in Kingston, Ontario.
W. Pickett (2014)
Problem Based Learning Discussions in Neuroanesthesia and Neurocritical Care
Hemanshu Prabhakar (2020)
Erratum: Can physician and patient gestalt lead to a shared decision to reduce unnecessary radiography in extremity trauma? (American Journal of Emergency Medicine 2015) 33 (1692-1699) DOI: 10.1016/j.ajem.2015.08.027)
Michael Mouw (2016)
Vertebral artery injury in patients with isolated transverse process fractures
Phillip A. Bonney (2017)
Current Challenges in the Use of Computed Tomography and MR Imaging in Suspected Cervical Spine Trauma.
Frank J. Minja (2018)
Prevertebral Soft-Tissue Swelling at C7 Is Highly Sensitive for Cervical Spine Ligamentous Injury Study Type: Retrospective Cohort Study
Jonathan C. Savakus (2020)
Spinal Immobilization in the Trauma Room - a Survey-Based Analysis at German Level I Trauma Centers.
Andreas Gather (2019)
Evaluating the cervical spine in confused or unconscious adults after blunt trauma.
Christopher G. Deacon (2019)
El diagnóstico de la lesión traumática cervical: una década de cambios basados en la evidencia
Diego B. Nuñez (2006)
Prospective evaluation of criteria for obtaining thoracolumbar radiographs in trauma patients.
J. Holmes (2003)
Interactions Between Psychosocial Problems and Management of Asthma: Who Is at Risk of Dying?
C. Barton (2005)
Utility of flexion–extension radiography for the detection of ligamentous cervical spine injury and its current role in the clearance of the cervical spine
J. J. Oh (2016)
Imaging after trauma to the neck
B. Wee (2008)
Initial Imaging Considerations, Repeat Imaging Frequency
K. Bochenek (2017)
Predicting intervention in renal colic patients after emergency department evaluation.
Linda Papa (2005)
Evidence-based emergency medicine/systematic review abstract. Is routine spinal immobilization an effective intervention for trauma patients?
Amado Alejandro Báez (2006)
Cervical Spine Injuries
M. Heinzelmann (2008)
MRI is unnecessary to clear the cervical spine in obtunded/comatose trauma patients: the four-year experience of a level I trauma center.
N. Tomycz (2008)
Does applying the Canadian Cervical Spine rule reduce cervical spine radiography rates in alert patients with blunt trauma to the neck? A retrospective analysis
U. Rethnam (2008)
College Football Player with Unstable C1 Fracture
Chris P Bales (2009)
Spine and Spinal Cord Injuries
Y. Klein (2009)
Chapter 50 – Advanced Imaging of the Spine
Linda J. Bagley (2011)
Clinical Decision Rule for C-Spine Clearance in the Netherlands, a National Survey
TP Saltzherr (2012)
Prehospital implementation of the Canadian C-Spine Rule.
Christopher R. Foerster (2014)
Airway management in cervical spine injured patients
Srikanth Sridhar (2014)
Can emergency nurses safely and accurately remove cervical spine collars in low risk adult trauma patients: An integrative review.
Nicola Smith (2016)
Missed cervical spine injuries: a national survey of the practice of evaluation of the cervical spine in confused and comatose patients.
Simon Craxford (2016)
Radiological investigations in spinal injuries
Thillainayagam Muthukumar (2016)
Clearing the Cervical Spine in Blunt Trauma
Margaret M. Griffen (2017)
See more
Semantic Scholar Logo Some data provided by SemanticScholar