Annals of Emergency Medicine
Volume 42, Issue 3 , Pages 395-402 , September 2003

The Canadian C-Spine rule performs better than unstructured physician judgment

  • Glen Bandiera, MD

      Affiliations

    • Division of Emergency Medicine, University of British Columbia, Vancouver, British Columbia, Canada
    • Corresponding Author InformationAddress for correspondence: Glen Bandiera, MD, Sunnybrook and Women's College Health Sciences Center, Suite BG-13, 2075 Bayview Avenue, North York, Ontario, Canada M4N 3M5
    • ,
  • Ian G Stiell, MD, MSc

      Affiliations

    • University of Toronto, Toronto, Ontario; the Department of Emergency Medicine, University of British Columbia, Vancouver, British Columbia, Canada
    • ,
  • George A Wells, PhD

      Affiliations

    • Department of Epidemiology and Community Medicine, University of British Columbia, Vancouver, British Columbia, Canada
    • ,
  • Catherine Clement, RN

      Affiliations

    • Clinical Epidemiology Unit, University of British Columbia, Vancouver, British Columbia, Canada
    • ,
  • Valerie De Maio, MD, MSc

      Affiliations

    • Clinical Epidemiology Unit, University of British Columbia, Vancouver, British Columbia, Canada
    • ,
  • Katherine L Vandemheen, BScN

      Affiliations

    • Clinical Epidemiology Unit, University of British Columbia, Vancouver, British Columbia, Canada
    • ,
  • Gary H Greenberg, MD

      Affiliations

    • University of Toronto, Toronto, Ontario; the Department of Emergency Medicine, University of British Columbia, Vancouver, British Columbia, Canada
    • ,
  • Howard Lesiuk, MD

      Affiliations

    • Division of Neurosurgery, University of British Columbia, Vancouver, British Columbia, Canada
    • ,
  • Robert Brison, MD, MPH

      Affiliations

    • University of Ottawa, Ottawa, Ontario; the Department of Emergency Medicine, University of British Columbia, Vancouver, British Columbia, Canada
    • ,
  • Daniel Cass, MD

      Affiliations

    • Division of Emergency Medicine, University of British Columbia, Vancouver, British Columbia, Canada
    • ,
  • Jonathan Dreyer, MD

      Affiliations

    • Queen's University, Kingston, Ontario; the Division of Emergency Medicine, University of British Columbia, Vancouver, British Columbia, Canada
    • ,
  • Mary A Eisenhauer, MD

      Affiliations

    • Queen's University, Kingston, Ontario; the Division of Emergency Medicine, University of British Columbia, Vancouver, British Columbia, Canada
    • ,
  • Iain MacPhail, MD, MHSc

      Affiliations

    • University of Western Ontario, London, Ontario; and the Division of Emergency Medicine, University of British Columbia, Vancouver, British Columbia, Canada
    • ,
  • R.Douglas McKnight, MD

      Affiliations

    • University of Western Ontario, London, Ontario; and the Division of Emergency Medicine, University of British Columbia, Vancouver, British Columbia, Canada
    • ,
  • Laurie Morrison, MD

      Affiliations

    • Division of Emergency Medicine, University of British Columbia, Vancouver, British Columbia, Canada
    • ,
  • Mark Reardon, MD

      Affiliations

    • University of Toronto, Toronto, Ontario; the Department of Emergency Medicine, University of British Columbia, Vancouver, British Columbia, Canada
    • ,
  • Michael Schull, MD, MSc

      Affiliations

    • Division of Emergency Medicine, University of British Columbia, Vancouver, British Columbia, Canada
    • ,
  • James Worthington, MBBS

      Affiliations

    • University of Toronto, Toronto, Ontario; the Department of Emergency Medicine, University of British Columbia, Vancouver, British Columbia, Canada
    • ,
  • Canadian C-Spine and CT Head Study Group

Received 18 October 2002 ,Revised 9 April 2003 ,Accepted 15 April 2003.

References 

    References
  1. Reid DC, Henderson R, Saboe L, et al.  Etiology and clinical course of missed spine fractures. J Trauma. 1987;27:980–986
  2. McCaig L. National Hospital Ambulatory Medical Care Survey: 1992 emergency department summary. Adv Data. 1994;245:1–12
  3. Diliberti T, Lindsey RW. Evaluation of the cervical spine in the emergency setting: who does not need an X-ray?. Orthopedics. 1992;15:179–183
  4. Bachulis BL, Long WB, Hynes GD, et al.  Clinical indications for cervical spine radiographs in the traumatized patient. Am J Surg. 1987;153:473–478
  5. McCaig LF. National Hospital Ambulatory Medical Care Survey: 2000 emergency department summaryAdvance Data From Vital and Health Statistics. Hyattsville, MD: National Center for Health Statistics; 2001;
  6. Stiell IG, Vandemheen K, Laupacis A, et al.  Variation in emergency department use of cervical spine radiography for alert, stable trauma patients. Can Med Assoc J. 1997;156:1537–1544
  7. McKee TR, Tinkoff G, Rhodes M. Asymptomatic occult cervical spine fracture: case report and review of the literature. J Trauma. 1990;30:623–626
  8. Roberge RJ, Wears RC, Kelly M, et al.  Selective application of cervical spine radiography in alert victims of blunt trauma: a prospective study. J Trauma. 1988;28:784–788
  9. Jacobs LM, Schwartz R. Prospective analysis of acute cervical spine injury: a methodology to predict injury. Ann Emerg Med. 1986;15:44–49
  10. American College of Surgeons . Advance Trauma Life Support Instructor Manual. 5th ed.. Chicago, IL: American College of Surgeons; 1993;
  11. Mirvis SE, Diaconis JN, Chirico PA, et al.  Protocol-driven radiologic evaluation of suspected cervical spine injury: efficacy study. Radiology. 1989;170(3, pt 1):831–834
  12. Davis JW, Phreaner DL, Hoyt DB, et al.  The etiology of missed cervical spine injuries. J Trauma. 1993;34:342–346
  13. Woodring JH, Lee C. Limitations of cervical radiography in the evaluation of acute cervical trauma. J Trauma. 1993;34:32–39
  14. McNamara RM, Heine E, Esposito B. Cervical spine injury and radiography in alert, high-risk patients. J Emerg Med. 1990;8:177–182
  15. Fischer RP. Cervical radiographic evaluation of alert patients following blunt trauma. Ann Emerg Med. 1984;13:905–907
  16. Gbaanador GB, Fruin AH, Taylon C. Role of routine emergency cervical radiography in head trauma. Am J Surg. 1986;152:643–648
  17. Bayless P, Ray VG. Incidence of cervical spine injuries in association with blunt head trauma. Am J Emerg Med. 1989;7:139–142
  18. Neifeld GL, Keene JG, Hevesy G, et al.  Cervical injury in head trauma. J Emerg Med. 1988;6:203–207
  19. Cadoux CG, White JD, Hedberg MC. High-yield roentgenographic criteria for cervical spine injuries. Ann Emerg Med. 1987;16:738–742
  20. McNamara RM, O'Brien MC, Davidheiser S. Post-traumatic neck pain: a prospective and follow-up study. Ann Emerg Med. 1988;17:906–911
  21. Kreipke DL, Gillespie KR, McCarthy MC, et al.  Reliability of indications for cervical spine films in trauma patients. J Trauma. 1989;29:1438–1439
  22. Hoffman JR, Schriger DL, Mower W, et al.  Low-risk criteria for cervical-spine radiography in blunt trauma: a prospective study. Ann Emerg Med. 1992;21:1454–1460
  23. Hills MW, Deane SA. Head injury and facial injury: is there an increased risk of cervical spine injury?. J Trauma. 1993;34:549–553
  24. Lindsey RW, Doherty BJ, Watson AB. Efficacy of radiographic evaluation of the cervical spine in emergency situations. South Med J. 1993;86:1253–1255
  25. Hoffman JR, Mower WR, Wolfson AB, et al.  Validity of a set of clinical criteria to rule out injury to the cervical spine in patients with blunt trauma: National Emergency X-Radiography Utilization Study Group. N Engl J Med. 2000;343:94–99
  26. Moloney TW, Rogers DE. Medical technology: a different view of the contentious debate over costs. N Engl J Med. 1979;301:1413–1419
  27. Angell M. Cost containment and the physician. JAMA. 1985;254:1203–1207
  28. Ontario Ministry of Health . The Ontario Statistical Reporting System 1993-94. Toronto, Ontario, Canada: Ontario Ministry of Health; 1994;
  29. Vandemark RM. Radiology of the cervical spine in trauma patients: practice pitfalls and recommendations for improving efficiency and communication. Am J Roentgenol. 1990;155:465–472
  30. Graham ID, Stiell IG, Laupacis A, et al.  Emergency physicians' views on the use of computed tomography and cervical spine radiography. J Int Soc Assessment Technol Health Care. 1998;14:31
  31. Stiell IG, Wells GA, McKnight RD, et al.  The Canadian C-Spine rule for alert and stable trauma patients, Part I: background and rationale. Can J Emerg Med. 2002;4:84–90
  32. Stiell IG, Wells GA, Vandemheen K, et al.  The Canadian CT Head rule for patients with minor head injury. Lancet. 2001;357:1391–1396
  33. Stiell IG, Wells GA, Vandemheen K, et al.  The Canadian Cervical Spine Radiography rule for alert and stable trauma patients. JAMA. 2001;286:1841–1848
  34. Laupacis A, Sekar N, Stiell IG. Clinical prediction rules: a review and suggested modifications of methodological standards. JAMA. 1997;277:488–494
  35. Stiell IG, Wells GA. Methodologic standards for the development of clinical decision rules in emergency medicine. Ann Emerg Med. 1999;33:437–447
  36. Stiell IG, Lesiuk H, Vandemheen K, et al.  Obtaining consensus for a definition of “clinically important cervical spine injury” in the CC Study. Acad Emerg Med. 1999;6:43–45
  37. Changaris D. Cervical spine films, cost, and algorithms. Am J Surg. 1987;153:478
  38. Long AE. Radiographic decision-making by the emergency physician. Emerg Med Clin North Am. 1985;3:437–446
  39. Feinstein AR. The “chagrin factor” and qualitative decision analysis. Arch Intern Med. 1985;145:1257–1259
  40. Stiell IG, McDowell I, Nair RC, et al.  Use of radiography in acute ankle injuries: physicians' attitudes and practice. CMAJ. 1992;147:1671–1678
  41. Stiell IG, Clement C, Wells GA, et al.  Multicentre prospective validation of the Canadian C-Spine rule [abstract]. Acad Emerg Med. 2002;9:359
  42. Stiell IG, McKnight R, Wells GA, et al.  Application of the Nexus Low-Risk Criteria for cervical spine radiography in Canadian emergency departments [abstract]. Acad Emerg Med. 2000;7:566

☆ Dr. Stiell holds a Distinguished Investigator Award and Dr. Schull a New Investigator Award, both from the Canadian Institutes of Health Research.Supported by peer-reviewed grants from the Medical Research Council of Canada (MT-13699) and the Ontario Ministry of Health Emergency Health Services Committee (11896N).Reprints not available from the authors.

PII: S0196-0644(03)00422-0

doi: 10.1016/S0196-0644(03)00422-0

Annals of Emergency Medicine
Volume 42, Issue 3 , Pages 395-402 , September 2003

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