Canadian Cervical Spine Rules

Purpose: The Canadian Cervical Spine Rules were developed in order to determine the need for radiographs after acute head/neck injury secondary to the risk of fracture.

Stage of CPR Development: Validated.

Rule:

High Risk Factors Present?
1. Age > 65
2. Dangerous Mechanism of Injury (i.e. fall > 1m or 5 stairs, axial load to head, high-speed motor vehicle accident, motorized recreational vehicle, bicycle collision)
3. Paresthesias in extremities

Low Risk Factors that allow safe assessment of range of motion?
1. Simple rear-end motor accident
2. Normal sitting posture in emergency department
3. Ambulatory at any time since injury
4. Delayed onset of neck pain and absence of midline tenderness

Is the patient able to actively rotate the neck > 45 degrees to the right and the left?

If there is (1) High Risk Factors or (2) Low Risk Factors and the inability to actively rotate the neck > 45 degrees to the right and the left, radiographs are indicated.

Interpretation:

Study	Sensitivity	Specificity	+LR	-LR
Stiell et al., 2001	1.00	0.43	1.74	0.01
Stiell et al., 2003	0.99	0.45	1.81	0.01
Miller et al., 2006	1.00	0.51	1.80	0.24
Rethnam et al., 2008	1.00	0.77	3.55	0.22
Stiell et al., 2009	1.00	N/A	N/A	N/A
Vaillancourt et al., 2009	1.00	0.38	1.55	0.10
Coffey et al., 2010	1.00	0.42	1.63	0.13
Stiell et al., 2010	0.90	0.44	1.61	0.22
Duane et al., 2011	1.00	0.01	1.00	0.42