Our radiologists have come across the Canadian C spine rule (Ref: Steill et
al, JAMA Oct 17 2001 286, 15 pp 1841- 1848) and reckon these would reduce
unnecessary neck x-rays. Anyone use them, anyone got any thoughts on how
easy to apply/ how much they reduce x-rays? Basically are they easier to use
or reduce radiation compared to EAST or NEXUS guidelines, and are they an
accepted standard of care?
(For those who've not seen them, the rules (which apply only to stable
patients, GCS 15) are:
1. High risk- 65 and over, Fall over 1 m/ axial load/ high speed RTA,
rollover or ejection/ bicycle or motorised recreation vehicle- x-ray.
Otherwise,
2. Any low risk factor to allow safe assessment of movement (only one factor
needed)- Simple shunt or sitting in ED or ambulatory at any time or delayed
onset pain or absence of midline tenderness? If not, x-ray. If any low risk
factor is present,
3. Able to actively rotate neck 45 degrees left and right? If not, x-ray. If
so, no need for x-ray.)
Matt Dunn
Warwick
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