At the end of the day my viewpoint is that you need to use clinical
acumen as well. Taking other factors into account. This I the problem
of calling them clinical decision rules as if they should be followed.
I think Some EBM experts prefer them to be called clinical decision
tools or instruments as something to aid decision making. I tend to
use NEXUS with the addition of ROM >45 degrees. In association with
history.
Andy
On 29 May 2010, at 03:59, Jel Coward <[log in to unmask]> wrote:
> Hi all
>
> ......I know, I know, I'm brain picking again.....sorry.
>
> There is a thing called the Canadian C-spine Rule.
>
> We are trying to come up with some guidelines for practice in the
> Canadian rurality, which as I am sure you can imagine, can be quite
> rural.
>
> I have a problem with the Canadian C-spine Rule in that it mandates
> c-spine xray (for many of us, immobilisation and transfer to a
> facility that has 24 hour x-ray - perhaps hours away - perhaps a
> flight away) based on _dangerous mechanism of injury_ alone.
>
> It describes a 'dangerous mechanism' as being
> - fall > 3 ft / 5 stairs
> - axial load to head eg. diving
> - MVC high speed (>100km/hr), rollover, ejection
> - motorised recreational vehicles (snowmobiles, ATVs, I think is
> meant)
> - bicycle collision
>
>
> It _mandates_ (it labels itself a Rule) - radiography of the neck
> for all of the above.
>
>
> Which seems a bit daft. I not infrequently see the ATV rollover guy
> or gal who rolls their machine in the hills, rights it, gets back
> on, rides out and comes in because they thing they sprained their
> thumb when it happens - otherwise asymptomatic and meeting NEXUS
> criteria - or similar scenarios.
>
>
> I have a colleague saying 'no, no, no we must use the Canadian C-
> spine rule in our teaching because it is the only 'rule' based on a
> _prospective_ study'.
>
>
>
> So.......how far off am I suggesting that we do what many ambulance
> services do, and emerg depts (I think) do - and use a clinical
> criteria based assessment tool rather than one that mandates x-ray
> based on 'what happened' (and not necessarily, what happened to the
> patient, either).
>
> Thoughts would be very welcome please - either way.
>
> Lastly - is the Can C-spine rule being used much in the UK and
> elsewhere?
>
> Thanks all :)
>
> Cheers
>
> Jel
|