William J. Meurer, MD, MS
In patients who are alert and stable after trauma, does the Canadian C-Spine Rule (CCR), when used by trained triage nurses, accurately identify patients with cervical-spine injury?
Blinded comparison of CCR with radiography and clinical records.
Emergency departments at 2 large teaching hospitals and 4 community hospitals in and near Ottawa, Ontario, Canada.
3633 patients ≥ 16 years of age (mean age 41 y, 54% women) who presented with potential cervical spine injury within 48 hours of blunt trauma, were alert (Glasgow Coma Scale score of 15), and in stable condition with normal vital signs. Exclusion criteria included penetrating trauma, acute paralysis or known vertebral disease, and referral from another hospital or reassessment of previously treated injury.
The CCR algorithm is based on 3 high-risk criteria, 5 low-risk criteria, and the ability of patients to actively rotate their necks 45 degrees left and right. Trained triage nurses used the CCR to assess patients. The CCR was also retrospectively used by the study investigators based on clinic notes.
Radiography and routine clinical information or, for patients who did not have radiography during the initial visit, return visits to emergency departments within 30 days.
Sensitivity and specificity of the CCR for identifying clinically important cervical-spine injury (any fracture, dislocation, or ligamentous instability requiring internal fixation or treatment with a halo, brace, or rigid collar).
42 patients (1.2%) had clinically important cervical-spine injuries. The CCR was indeterminate for 99 patients (2.7%) when used by nurses and 181 (5.0%) patients when used by investigators (Table). Test characteristics for the CCR, based on the remaining patients, are in the Table.
In patients who are alert and stable after trauma, the Canadian C-Spine Rule, used by trained triage nurses, had high sensitivity for identifying patients with cervical-spine injury.
Diagnostic characteristics of the Canadian C-Spine Rule for identifying clinically important cervical-spine injury after trauma*
*Diagnostic terms defined in Glossary. LRs calculated from data in article.
Meurer WJ. The Canadian C-Spine Rule, used by nurses, accurately identified cervical-spine injury in patients with trauma. Ann Intern Med. ;154:JC1–13. doi: 10.7326/0003-4819-154-2-201101180-02013
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Published: Ann Intern Med. 2011;154(2):JC1-13.
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