THE CANADIAN C-SPINE RULES

This is a flowsheet representation of the Canadian C-Spine Rules for alert (GCS=15) and stable trauma patients where C-spine injury a concern

Begin flowsheet

The adaptation is made from a number of sources.

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1. Any High-Risk Factor Which Mandates Radiography?

Age > 65 years

or

Dangerous mechanism

or

Paresthesiae in extremities

YES NO

2. Any Low-Risk Factor Which Allows Safe Assessment of Range of Motion?

Simple rearend MVC

or

Sitting position in ED

or

Ambulatory at any time

or

Delayed onset of neck pain

or

Absence of midline C-spine tenderness

YES NO

3. Able to Actively Rotate Neck?

45 degrees left and right

YES NO

NO RADIOGRAPH

Dangerous Mechanism

· fall from elevation > 3 feet / 5 stairs

· axial load to head, eg. diving

· MVC high speed ( >100 km / hr. ), rollover, ejection

· motorized recreational vehicles

· bicycle collision

Simple Rearend MVC Excludes: **

· pushed into oncoming traffic

· hit by bus / large truck

· rollover

· hit by high speed vehicle

Delayed:

ie. not immediate onset of neck pain

RADIOGRAPHY INDICATED

Adapted from:

CJEM Mar 9 2002;4(2)

JAMA 2001; 286(15): 1841-1848

Adapted by: N.J. Bosomworth ,MD, CCFP, FCFP