CanadiEM MVP Infographic Series – CCR vs NLC in Patients with Trauma

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In this issue of the MVP Infographic Series, we feature: “The Canadian C-Spine Rule versus the NEXUS Low-Risk Criteria in Patients with Trauma” published by Stiell I. et al.​1​

Emergency departments in the USA and Canada deal with 13 million trauma patients who are at risk for c-spine injury; a even smaller portion of these patients have a cervical-spine fracture. Although cervical spine xrays are a low-cost item, their excessive use leads to large costs. Therefore clinical-decision tools have been developed to increase the efficiency of xray use. Currently the two most popular clinical-decision tools is the Canadian C-Spine Rule (CCR) and the NEXUS Low-Risk Criteria (NLC).

Stiell et al. compared the CCR and NLC in terms of sensitivity, specificity, and xray use. Results are above. Limitations exist in this study. Not all patients underwent radiology, particularly patients in Canada who were deemed as low-risk. Some CCR cases were indeterminate as physicians were uncomfortable in some cases to test range of motion of the neck. The rate for CCR misinterpretation was slightly higher than NLC as it is a more complex rule. However interpretation rates were similar between the two.

In conclusion, for alert and stable patients the CCR is superior to the NLC in respect to sensitivity and specificity of cervical-related injuries, and its use would reduce the number of xrays.

  1. 1.
    Stiell IG, Clement CM, McKnight RD, et al. The Canadian C-Spine Rule versus the NEXUS Low-Risk Criteria in Patients with Trauma. N Engl J Med. December 2003:2510-2518. doi:10.1056/nejmoa031375
Anson Dinh

Anson Dinh

Anson Dinh is a medical student at the University of Saskatchewan, Class of 2021. His academic interests involve ultrasound and simulations. His hobbies include bouldering, journaling, and collecting fountain pens.
Alvin Chin

Alvin Chin

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.