Daily Bolus of LR: Decision Rules for C-spine Injury

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October 21, 2011 by dailybolusoflr

Decision Rules for C-Spine Injury


The two most commonly used decision rules for C-Spine injury are Nexus and the Canadian C-Spine rules.  Both rules are published in the literature with the end point of decreasing the use of unnecessary imaging in low risk patients.


Both decision rules can be questionable when being applied to children.  Canadian C-Spine requires all patients over the age of 65 to be imaged while NEXUS allows use of the rule after subgroup analysis of their data (granted only 8% of patients in this large group was over the age of 65. . .)


A recap is below:



The patient must NOT have any of the following:

1.       No midline tenderness

2.       No focal neurological deficit

3.       No altered mental status

4.       No intoxication

5.       No distracting injury


Canadian C-Spine

1.       Any high risk factor that mandates radiography?

a.       Age >65

b.      Dangerous mechanism (fall over 1 meter, axial loading injury, high speed MVC/rollover or ejection, or collision while using a motorized recreation vehicle or bike)

c.       Presence of paresthesias in extremities

2.       Any low risk factor that allows for safe assessment of range of motion?

a.       Ambulatory  at any time

b.      Be without midline tenderness

c.       Be without immediate onset of pain

d.      Be able to sit up in the ED

e.      Be involved in only a simple rear end collision (NOT-pushed into traffic, hit by a large bus or truck, involved in a rollover or hit by a high speed vehicle)

3.       The patient must be able to actively rotate their neck 45 degrees to the right AND left (regardless of pain)


Ref: Stiell I et al. JAMA 2001; 286(15):1841-1848 and Hoffman J et al. Ann Emerg Med. 1998; 32:461-469.

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