#Canadian c spine rules driver

When assessed, she can rotate her neck 45° right and left. Using CCR, the patient has no high-risk criteria, and she has at least one low risk criteria allowing assessment of active range of motion (ambulatory on scene, simple rear-end motor vehicle collision). And as always, clinical judgment and appropriate interpretation are key. Both the NEXUS criteria and the CCR should be used as tools, not rules. Patients that may not be evaluated adequately with one tool can potentially be evaluated with the other. Physicians should be aware of the populations to which these rules apply and can benefit from knowledge of both. When compared to the NEXUS criteria, the CCR is slightly more complicated and has stricter exclusion criteria, but it has higher sensitivity. Physicians should have a low threshold for CT in this population. A recent study found a reduction in NEXUS criteria sensitivity from 84.2% to 65.9% in elderly patients (age ☶5) with acute blunt trauma when compared to non-elderly patients. Both rules, if applied appropriately, have the potential to reduce imaging rates (by 44% for CCR and 36% for NEXUS criteria).Īs a final caution, although the NEXUS criteria have no age limitation, clinicians must beware of its use in the elderly. Furthermore, one study directly comparing the two rules showed better diagnostic accuracy for the CCR. A recent systematic review, however, found sensitivities for CCR and the NEXUS criteria of 90-100% and 83-100%, respectively. The sensitivity of both rules for detecting clinically significant C-spine injuries in their own validation studies were 100%. The NEXUS criteria are simple to use and can be widely applied to the ED patient population.įigure 2. The only exclusion criteria are patients with penetrating trauma and those who had a C-spine x-ray for reasons other than trauma. (See Figure 2) “Intoxication” and “level of alertness” are further defined in the original paper these criteria and “painful distracting injury”, however, must be interpreted by the attending physician. These criteria include: No posterior midline cervical spine tenderness no evidence of intoxication normal level of alertness no focal neurologic deficit and no painful distracting injuries. It consists of five low-risk criteria if the patient does not meet all five criteria, he or she requires C-spine x-rays. The NEXUS criteria was developed by Hoffman and colleagues in 1998 and is validated for use in the ED. Return visit for reassessment of same injury Known vertebral disease (ankylosing spondilitis, rheumatoid arthritis, spinal stenosis, previous spinal surgery) (Diagram has been re-designed by the team for clarity – click on the diagram to link to a higher-resolution version of the picture) It uses 3 primary factors to determine whether a given patient needs imaging: 1) Is there any high-risk factor that mandates radiography? 2) Is there any low-risk factor that allows safe assessment of range of motion? 3) Can the patient actively rotate his or her neck 45° right and left? (See Figure 1) Strict exclusion criteria eliminate some of the ED population. Since then, the CCR has been validated for use in the emergency department, at triage, and by paramedics in the field. The CCR was developed by Stiell and colleagues in 2001. The Canadian C-Spine Rule (CCR) and the National Emergency X-Radiography Utilization Study Low-Risk Criteria (NEXUS criteria) are clinical decision tools developed to help us decide when blunt trauma patients require C-spine X-ray. NEXUS) should you use to asses this patient? The Analysis: Which clinical decision rule (Canadian C-spine vs. She is now on a stretcher in your emergency department. She did complain of midline C-spine tenderness as a result, she was boarded and collared prior to transport. On examination by paramedics, the young woman denied paraesthesias. She was wearing a seatbelt and her airbags did not deploy.

#Canadian c spine rules driver

A 32-year-old female was the driver in a simple rear-end motor vehicle collision at about 40km/h.