On the Shoulders of Giants
Why does this matter?
C-spine imaging is costly, time consuming for patients, and exposes them to radiation. 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 x-ray or CT. We covered NEXUS, which came out in 2000. This rule came out the following year, with lead author Ian Stiell (aka @EMO_Daddy), and seemed to have better performance. Then, just as in hockey, Canada took on the US and won when the Canadian and NEXUS rules were compared head to head.
O Canada! Our home and native land!
There are a lot of exclamation points in that song! This was a prospective convenience sample of 8924 adult patients with blunt trauma who were slated to undergo c-spine imaging. This was the derivation study, which came up with the following 3 questions with 100% sensitivity and 42.5% specificity for clinically important c-spine injuries. They are quoted here:
- (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)?
- (3) is the patient able to actively rotate neck 45 degrees to the left and right?
The Canadian C-spine rule for radiography in alert and stable trauma patients. JAMA. 2001 Oct 17;286(15):1841-8.