A patient’s neck can be clinically cleared
safely without radiographic imaging if ALL 5 low-risk conditions are NEGATIVE: (mnemonic: NSAID)
1. Focal Neurological
deficit
2. Spinal
(posterior midline) tenderness
3. Altered
mental status
4. Intoxication
5. Clinically apparent, painful Distracting injury
Canadian C-spine Rules (CCR) NEJM2003;349:2510 –2518
The
Canadian C-spine rule versus the NEXUS low-risk criteria in patients with
trauma. N Engl J Med. 2003 Dec
25;349(26):2510-8.
CCR was more sensitive
than the NLC (99.4 % vs. 90.7 %, P<0.001) and more specific
(45.1 %
vs. 36.8 %, P<0.001) for injury, and its use would have resulted in lower
radiography rates (55.9 % vs. 66.6 %, P<0.001).
In secondary
analyses that included all patients, the sensitivity and specificity of CCR,
assuming that the indeterminate cases were all positive, were 99.4 % and 40.4 %,
respectively (P<0.001 for both comparisons with the NLC). Assuming that the
CCR was negative for all indeterminate cases, these rates were 95.3 % (P=0.09
for the comparison with the NLC) and 50.7 % (P=0.001). The CCR would have
missed 1 patient and the NLC would have missed 16 patients with important
injuries.
Conclusion: For alert patients with trauma who are
in stable
condition, the CCR is superior to the NLC with respect
to sensitivity and specificity for cervical-spine injury