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Canadian C-Spine Rule
Whether cervical-spine imaging is needed after blunt trauma.
Canadian C-Spine Rule
High risk: age >=65 years
High risk: dangerous mechanism
Fall >=1 m/5 stairs, axial load to head, high-speed MVC (>100 km/h) / rollover / ejection, motorised recreational vehicle, or bicycle collision.
High risk: paraesthesias in the extremities
Any low-risk factor allowing safe ROM assessment present
Simple rear-end collision, sitting upright in the ED, ambulatory at any time, delayed onset of neck pain, or absence of midline tenderness.
Able to actively rotate neck 45 degrees left and right
ResultImaging indicated
Cervical-spine radiography is recommended before clinical clearance.
When to use
- Alert (GCS 15), stable adult trauma patients where cervical injury is a concern.
- Not for penetrating trauma, known vertebral disease, or non-trauma neck pain.
Formula
Imaging required if any high-risk factor (age >=65, dangerous mechanism, extremity paraesthesias); OR if no low-risk factor permits safe range-of-motion testing; OR if the patient cannot actively rotate the neck 45 degrees to each side.
Pearls and pitfalls
- Highly sensitive for clinically important cervical injury when applied to eligible patients.
- Range of motion is tested only after high-risk factors are excluded and a low-risk factor is present.