Stiell IG, Wells GA, Vandemheen KL, et al. JAMA 2001 · PMID 11597285 · doi:10.1001/jama.286.15.1841
- Question
- Can a clinical decision rule safely identify alert, stable trauma patients who need cervical spine imaging?
- Design
- Prospective multicentre derivation cohort study in Canadian emergency departments.
- Patients
- Alert (GCS 15), haemodynamically stable adults with blunt head or neck trauma.
- Intervention
- Canadian C-spine rule (high-risk factors, low-risk factors allowing assessment of range of motion, and ability to rotate the neck 45 degrees each way)
- Comparison
- Reference standard of imaging or structured follow-up for clinically important cervical spine injury
- Primary outcome
- Sensitivity and specificity for clinically important cervical spine injury
- Key result
- The derived rule had very high sensitivity for clinically important cervical spine injury while potentially reducing the number of radiographs ordered.
- Limitations
- Derivation study only, later validated separately; excludes patients with altered consciousness, children and those with unstable vital signs.
- Impact on practice
- Adopted in NICE head injury guidance (NG232) to decide which adults need cervical spine imaging, with CT now the first-line modality.