CCR v.1

The Canadian C-spine Rule (CCR) helps to safely rule out CSI (Cervical spine injury) in trauma patients who are in a stable and alert condition without needing to resort to taking radiographic images.

Syeeda S Farruque

models@cambiocds.com

© Cambio Healthcare Systems

The Canadian C-spine Rule (CCR) helps to safely rule out CSI (Cervical spine injury) in trauma patients who are in a stable and alert condition without needing to resort to taking radiographic images.

There are a series of exclusion criteria that have to be taken into account before using the tool which are outlined in the Misuse section. Inclusion criteria: - If a patient has any high risk factors (age > 65, a defined dangerous mechanism (see below) or paresthesias in the arms or legs) then they require c-spine imaging. Dangerous mechanism: Fall from elevation >= 3 feet/5 stairs Axial load to head e.g. diving MVC (motor vehicle collision) high speed (>100km/hr), rollover, ejection Motorized recreational vehicles Bicycle collision - If a patient has no high risk factors but meets none of the defined low risk criteria (see list), they require c-spine imaging. Sitting position in the ED Ambulatory at any time Delayed (not immediate onset) neck pain No midline tenderness. Simple rear-end motor vehicle collision (MVC) not simple if: pushed into traffic, hit by bus/large truck, rollover, hit by high-speed vehicle. - If a patient has no high risk factors, has neck pain, but meets even one low risk factor, then it is safe to assess whether the patient is able to rotate their neck 45 degrees to the left and right. - If they can do this (even with some pain or discomfort), then they do not require further imaging. - If they cannot rotate their neck 45 degrees in both directions then c-spine images are indicated.

Do not use if any of the following exclusion criteria are present: Exclusion Criteria: Non-trauma Patients GCS <15 Unstable Vital Signs Age <16 Years Acute Paralysis Known Vertebral Disease Previous C-Spine Surgery

Ref. 1: Stiell IG, Wells GA, Vandemheen KL, Clement CM, Lesiuk H, De Maio VJ, Laupacis A, Schull M, McKnight RD, Verbeek R, Brison R, Cass D, Dreyer J, Eisenhauer MA, Greenberg GH, MacPhail I, Morrison L, Reardon M, Worthington J. The Canadian C-spine rule for radiography in alert and stable trauma patients. JAMA. 2001 Oct 17;286(15):1841-8. PubMed PMID: 11597285

OBSERVATION.canadian_c_spine_rule.v1, EVALUATION.canadian_c_spine_assessment.v1