CanadiEM MVP Infographic Series – The Canadian C-spine rule for radiography in alert and stable trauma patients

In Featured, Infographics, Medical Concepts by Kevin LamLeave a Comment

This issue of the MVP Infographic Series is focused on “The Canadian C-spine rule for radiography in alert and stable trauma patients” published by Stiell et al.1

Prior to the use of clinical decision rules, such as the Canadian C-spine Rule (CCR), clinicians varied up to 6-fold in how often they ordered C-spine X-rays. Although such X-rays have a low individual cost, they carry a high systems-level cost due to the volume of tests ordered. As such, a good clinical decision rule with high sensitivity to rule out C-spine injuries was much needed.

Prior to the development of the CCR, the NEXUS criteria with a sensitivity of 99.6% was promising; however, it was found that when the rule was applied in other jurisdictions, there would be more X-rays ordered due to the low specificity of 12.9%.

The methods and results of the study are highlighted in the infographic. This study had some limitations, the most common being that the algorithm is complex. With the proliferation of medical calculators, however, this has simplified the process. If you want help with memorising the rule, Dr. Teresa Chan previously published an excellent way to memorise the CCR.

The CCR was found to have a 100% sensitivity and 42.5% specificity, when applied by physicians. This rule has also been validated in multiple centres and there is now evidence of the use of the CCR by nurses and paramedics, which could drastically reduce the amount of discomfort alert and stable trauma patients experience. 1 2 3

Stiell I, Clement C, 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(11):1173-1179. [PubMed]
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(10):873-876. [PubMed]
Vaillancourt C, Stiell I, Beaudoin T, et al. The out-of-hospital validation of the Canadian C-Spine Rule by paramedics. Ann Emerg Med. 2009;54(5):663-671.e1. [PubMed]
Kevin Lam

Kevin Lam

Kevin is a third year medical student at McMaster University. He is a junior editor for CanadiEM and has interests in medical education, graphic creation and the intersections between design, urban design and medicine.
Alvin is currently a PGY5 in the FRCP EM program at McMaster University. He serves as Director of Design for CanadiEM and has interests in knowledge translation and health innovation.