Annals of Emergency Medicine
Volume 54, Issue 5 , Pages 663-671.e1 , November 2009

The Out-of-Hospital Validation of the Canadian C-Spine Rule by Paramedics

Presented at the Society for Academic Emergency Medicine annual scientific meeting, May 2007, Chicago, IL; and the Canadian Association of Emergency Physicians annual meeting, June 2007, Victoria, BC, Canada.

  • Christian Vaillancourt, MD, MSc

      Affiliations

    • Department of Emergency Medicine, University of Ottawa, Ottawa, Ontario, Canada
    • Ottawa Health Research Institute, University of Ottawa, Ottawa, Ontario, Canada
    • Corresponding Author InformationAddress for correspondence: Christian Vaillancourt, MD, MSc, Ottawa Hospital, Civic Campus, Clinical Epidemiology Unit, F658, 1053 Carling Avenue, Ottawa, Ontario, Canada K1Y 4E9; 613-798-5555 ext.17012, fax 613-761-5351
    • ,
  • Ian G. Stiell, MD, MSc

      Affiliations

    • Department of Emergency Medicine, University of Ottawa, Ottawa, Ontario, Canada
    • Ottawa Health Research Institute, University of Ottawa, Ottawa, Ontario, Canada
    • ,
  • Tammy Beaudoin, CHIM

      Affiliations

    • Ottawa Health Research Institute, University of Ottawa, Ottawa, Ontario, Canada
    • ,
  • Justin Maloney, MD

      Affiliations

    • Department of Emergency Medicine, University of Ottawa, Ottawa, Ontario, Canada
    • ,
  • Andrew R. Anton, MD

      Affiliations

    • City of Calgary Emergency Medical Services, Calgary, Alberta, Canada
    • ,
  • Paul Bradford, MD

      Affiliations

    • Essex-Kent Base Hospital, Hotel Dieu Grace Hospital, Windsor, Ontario, Canada
    • ,
  • Ed Cain, MD

      Affiliations

    • Department of Emergency Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
    • ,
  • Andrew Travers, MD, MSc

      Affiliations

    • Emergency Health Services, Halifax, Nova Scotia, Canada
    • ,
  • Matt Stempien, MD

      Affiliations

    • Department of Emergency Medicine, Joseph Brant Hospital, Burlington, Ontario, Canada
    • ,
  • Martin Lees, MD

      Affiliations

    • Department of Emergency Medicine, Bluewater Health, Sarnia, Ontario, Canada
    • ,
  • Doug Munkley, MD

      Affiliations

    • Niagara Base Hospital, Niagara Falls, Ontario, Canada
    • ,
  • Erica Battram, RN

      Affiliations

    • Ottawa Health Research Institute, University of Ottawa, Ottawa, Ontario, Canada
    • ,
  • Jane Banek, CHIM

      Affiliations

    • Ottawa Health Research Institute, University of Ottawa, Ottawa, Ontario, Canada
    • ,
  • George A. Wells, PhD

      Affiliations

    • Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
    • Ottawa Health Research Institute, University of Ottawa, Ottawa, Ontario, Canada

Received 27 August 2008 ,Revised 20 January 2009 ,Accepted 4 March 2009.

References 

  1. Nawar EW, Niska RW, Xu J. National Hospital Ambulatory Medical Care Survey: 2005 Emergency Department Summary (Advance Data From Vital and Health Statistics; No. 386). Hyattsville, MD: National Center for Health Statistics; 2007;
  2. 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. 2003;349:2510–2518
  3. American College of Surgeons. Advanced Trauma Life Support Student Course Manual. 7th ed.. Chicago, IL: American College of Surgeons; 2004;
  4. Kwan I, Bunn F, Roberts I WHOP-HTCSC. Spinal immobilisation for trauma patients (Cochrane Review). Cochrane Database Syst Rev. 2002;(2):CD002803
  5. Bauer SJ, Kowalski R. Effect of spinal immobilization devices on pulmonary function in the healthy, nonsmoking man. Ann Emerg Med. 1988;17:915–918
  6. March JA, Ausband SC, Brown LH. Changes in physical examination caused by use of spinal immobilization. Prehosp Emerg Care. 2002;6:421–424
  7. Schull M, Szalai JP, Schwartz B, et al. Emergency department overcrowding following systematic hospital restructuring: trends at twenty hospitals over ten years. Acad Emerg Med. 2001;8:1037–1043
  8. Vandemark RM. Radiology of the cervical spine in trauma patients: practice pitfalls and recommendations for improving efficiency and communication. AJR Am J Roentgenol. 1990;155:465–472
  9. Stiell IG. Clinical decision rules in the emergency department. CMAJ. 2000;163:1465–1466
  10. Stiell IG, Wells GA, Vandemheen KL, et al. The Canadian C-Spine Rule for radiography in alert and stable trauma patients. JAMA. 2001;286:1841–1848
  11. Domeier RM, Frederiksen SM, Welch K. Prospective performance assessment of an out-of-hospital protocol for selective spine immobilization using clinical spine clearance criteria. Ann Emerg Med. 2005;46:123–131
  12. Domeier RM, Swor RA, Evans RW, et al. Multicenter prospective validation of prehospital clinical spinal clearance criteria. J Trauma. 2002;53:744–750
  13. Stroh G, Braude D. Can an out-of-hospital cervical spine clearance protocol identify all patients with injuries? (an argument for selective immobilization). Ann Emerg Med. 2001;37:609–615
  14. Teasdale G, Jennett B. Assessment of coma and impaired consciousness: a practical scale. Lancet. 1974;2:81–84
  15. Stiell IG, Lesiuk H, Vandemheen K, et al. Obtaining consensus for a definition of “clinically important cervical spine injury” in the CCC Study. Acad Emerg Med. 1999;6:435
  16. Stiell IG, Vandemheen K, Brison R, et al. Validity evaluation of the cervical spine injury proxy outcome assessment tool in the CCC Study. Acad Emerg Med. 1999;6:434
  17. Landis JR, Koch GG. The measurement of observer agreement for categorical data. Biometrics. 1977;33:159–174
  18. Muhr MD, Seabrook DL, Wittwer LK. Paramedic use of a spinal injury clearance algorithm reduces spinal immobilization in the out-of-hospital setting. Prehosp Emerg Care. 1999;3:1–6
  19. 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
  20. Hauswald M, Ong G, Tandberg D, et al. Out-of-hospital spinal immobilization: its effect on neurologic injury. Acad Emerg Med. 1998;5:214–219

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 Supervising editor: Kathy J. Rinnert, MD, MPH

 Author contributions: CV and IGS applied for funding. CV and TB helped clean the database. CV monitored study progression, recruited centers, organized training, performed analyses, and wrote the paper. IGS, TB, JM, ARA, PB, EC, AT, MS, ML, DM, EB, JB, and GAW critically reviewed and helped edit the article. IGS developed the original rule and training material. TB acted as study coordinator. JM, ARA, PB, EC, AT, MS, ML, and DM acted as site coordinators, overseeing all local aspects of study site implementation. EB was the study nurse, reviewed all data collection sheets before data entry, and performed patient follow-up. JB acted as interim study coordinator. TB and JB monitored all aspects of the study. CV and GAW helped develop the study methodology. CV takes responsibility for the paper as a whole.

 Funding and support: By Annals policy, all authors are required to disclose any and all commercial, financial, and other relationships in any way related to the subject of this article that might create any potential conflict of interest. See the Manuscript Submission Agreement in this issue for examples of specific conflicts covered by this statement. The authors are indebted to the Physicians' Services Incorporated Foundation and the Ontario Ministry of Health and Long-Term Care for their financial support of this study.

 Publication date: Available online April 24, 2009.

 Reprints not available from the authors.

PII: S0196-0644(09)00241-8

doi: 10.1016/j.annemergmed.2009.03.008

Annals of Emergency Medicine
Volume 54, Issue 5 , Pages 663-671.e1 , November 2009

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