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ACAD-AE-MED  May 2010

ACAD-AE-MED May 2010

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Subject:

Re: Canadian C-spine rule

From:

Jel Coward <[log in to unmask]>

Reply-To:

Accident and Emergency Academic List <[log in to unmask]>

Date:

Sat, 29 May 2010 08:42:33 -0400

Content-Type:

text/plain

Parts/Attachments:

Parts/Attachments

text/plain (107 lines)

Suzanne Mason wrote:
> Hi jel. I am sure ian would be happy to be contacted. 
I have just emailed him - thanks for this and to Rowley for providing 
the address.

> I know they have done some work on using the rule in PHC settings. Jonathan benger in Bristol has also written a paper about PHC use which I think was in the european journal. An academic fellow of mine has also done a systematic review which you might find helpful. I will try + send it on next week as on my way to holidays just now!
>   
Yes please :)

Thanks to all who have replied.

Can I re-ask my supplementary question though, please - how many folks 
are using the Canadian C-spine Rule in the UK?  (_and_ thus  x-raying 
just based on the mechanism of injury as is suggested).


Jel


> Sue mason
> Sent from my BlackBerry® wireless device
>
> -----Original Message-----
> From:         Andrew Webster <[log in to unmask]>
> Date:         Sat, 29 May 2010 07:06:01 
> To: <[log in to unmask]>
> Subject: Re: Canadian C-spine rule
>
> 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
>>     


-- 
Jel
Visit the OSCAR Canada Users Society
http://OSCARcanada.org
and learn about a world leading open-source Electronic Medical Record

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