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Canadian c spine rules trial#

Spinal collars were introduced in 1967 into the management of spinal trauma care as it was thought that this technique of immobilisation would prevent any further neurological or spinal damage in high-risk patients. The modified Canadian C-spine rule has fewer variables than the original Canadian C-spine rule and is entirely based on physical examination, which seems easier to use in emergency departments. The sensitivities of NEXUS criteria, Canadian C-spine, and modified Canadian C-spine rule were 93.4%, 100.0% and 100.0%, respectively. The area under the curve of the NEXUS criteria, Canadian C-spine, and modified Canadian C-spine rule were 0.76, 0.78 (95% CI 0.74-0.83), and 0.79 (95% CI 0.74-0.83), respectively. In addition, modified Canadian C-spine rule was derived by removing dangerous mechanism and simple rear-end motor vehicle collision from the model.ĭata from 673 patients were included. Afterward, all patients underwent cervical imaging. Emergency physicians evaluated the patients based on the Canadian C-spine rule and NEXUS criteria in two groups of low risk and high risk for clinically important cervical spine injury. Finally, we introduced the modified Canadian C-spine rule.Ī prospective diagnostic accuracy study was conducted on trauma patients referred to four emergency departments of Iran in 2018. Therefore, the aim of the present study was to compare the accuracy of the Canadian C-spine and NEXUS criteria in ruling out clinically important cervical spine injuries in trauma patients. To view Dr.Although, Canadian C-spine rule and the National Emergency X-Radiography Utilization Study (NEXUS) criteria in ruling out clinically important cervical spine injuries have been validated using large prospective studies, no consensus exist as to which rule should be endorsed.

Stiell is a Member of the Institute of Medicine of the U.S. Stiell is the Principal Investigator for 1 of 3 Canadian sites in the Resuscitation Outcomes Consortium (ROC) which is funded by CIHR, NIH, HSFC, AHA, and National Defence Canada. He is best known for the development of the Ottawa Ankle Rule, the Canadian C-Spine Rule, and Canadian CT Head Rule and as the Principal Investigator for the landmark OPALS Studies for prehospital care.

He is internationally recognized for his research in emergency medicine with a focus on the development of clinical decision rules and the conduct of clinical trials involving acutely ill and injured patients treated by prehospital services and in emergency departments. Ian Stiell, MD, MSc, FRCPC, is Professor and Chair, Department of Emergency Medicine, University of Ottawa Distinguished Professor and University Health Research Chair, University of Ottawa Senior Scientist, Ottawa Hospital Research Institute and Emergency Physician, The Ottawa Hospital.

Canadian c spine rules trial#

The lone trial with a sensitivity of 90% was in a study where nurses were trained to apply the rule (retrospective review by investigators in this study found the rule was misapplied in 4 cases with obvious high-risk features) it has also been successfully evaluated in paramedics.

Some practice environments might be concerned with identifying any cervical spine injury (CCR is highly sensitive for clinically important c-spine imaging.)

The quoted sensitivities are all for CSI.

The rule can be used in patients who are intoxicated if the patients are alert and cooperative, the rule can be used regardless of blood alcohol content.

Most common criticism is that the CCR is difficult to memorize due to its multiple criteria use of a smartphone app or digital reference (like MDCalc) is recommended.

Not all patients in the validation study underwent imaging if the treating physician felt the patient was at very low risk of injury.

Subsequent studies have found a sensitivity of 90-100% for CSI with majority finding 99-100% sensitivity.

Applying the Canadian C-Spine Rule would allow healthcare providers to safely decrease the need for imaging among this patient population by over 40%.

CCR is highly sensitive for CSI, with the majority of studies finding it catches 99-100% of these types of injuries.

The Canadian C-spine Rule (CCR) was developed to help physicians determine which trauma patients need c-spine imaging.