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.


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.


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


1. Stiell IG, Wells GA, Vandemheen KL, et al. The Canadian C-spine rule for radiography in alert and stable trauma patients. JAMA 2001;286:1841-8.

2. Stiell IG, Clement CM, McKnight RD, et al. The Canadian Cspine rule versus the NEXUS low-risk criteria in patients with trauma. N Engl J Med 2003;349:2510-8.

3. Miller P, Coffey F, Reid AM, et al. Can emergency nurses use the Canadian cervical spine rule to reduce unnecessary patient immobilisation? Accid Emerg Nurs 2006;14:133-40.

4. Rethnam U, Yesupalan R, Gandham G. Does applying the Canadian Cervical Spine rule reduce cervical spine radiography rates in alert patients with blunt trauma to the neck? A retrospective analysis. BMC Med Imaging 2008;8:12.

5. Stiell IG, Clement CM, Grimshaw J, et al. Implementation of the Canadian C-Spine Rule: prospective 12 centre cluster randomised trial. BMJ 2009;339:b4146.

6. Vaillancourt C, Stiell IG, Beaudoin T, et al. The out-of-hospital validation of the Canadian C-Spine Rule by paramedics. Ann Emerg Med 2009;54:663-71.

7. Coffey F, Hewitt S, Stiell I, et al. Validation of the Canadian c-spine rule in the UK emergency department setting. Emerg Med J 2011; 28:873-6.

8. Stiell IG, Clement CM, O’Connor A, et al. Multicentre prospective validation of use of the Canadian C-Spine Rule by triage nurses in the emergency department. CMAJ 2010;182:1173-9.

9. Duane TM, Wilson SP, Mayglothling J, et al. Canadian Cervical Spine rule compared with computed tomography: a prospective analysis. J Trauma 2011;71:352-5.

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