The Canadian C-Spine Rule (CCR) is a clinical decision-making tool that guides clinicians in determining the need for cervical spine imaging in trauma patients. It is designed to identify patients who require imaging based on specific criteria, helping to avoid unnecessary radiography while ensuring that significant injuries are not missed.

It is widely used in clinical practice and is advocated by both the ATLS and NICE guidelines on the assessment of spinal injuries. In addition, it is a common exam topic, both in undergraduate and postgraduate exams, so it is important to be familiar with the key details and components of the rule.

Key Components of the Rule

High-Risk Factors:

The rule begins by assessing for high-risk factors that necessitate imaging regardless of clinical assessment. These include age ≥ 65 years, dangerous mechanism of injury (e.g., fall from a significant height or motor vehicle collision), and paraesthesias in extremities.

Low-Risk Factors:

Patients who do not present with high-risk factors are further assessed based on low-risk criteria, which, if met, indicate that imaging is unnecessary unless certain clinical assessments fail.

The full Canadian C-spine Rule

The complete Canadian C-spine rule is shown below:

Exam Tips

Memorise the criteria:

Familiarise yourself with both the high-risk and low-risk criteria outlined in the Canadian C-Spine Rule. This includes understanding the specific components such as age, mechanism of injury, and clinical signs.

Practice clinical scenarios:

Work through clinical scenarios where the Canadian C-Spine Rule might be applied. This can help reinforce when imaging is necessary based on the rule’s guidelines.

Understand clinical decision-making:

Study how the rule integrates into clinical decision-making. Knowing when to apply the rule and how to interpret its results is key to its effective use in practice and exams.

Compare with other guidelines:

Understand how the Canadian C-Spine Rule aligns or contrasts with other guidelines, such as the NEXUS criteria.


The Canadian C-Spine Rule for Radiography in Alert and Stable Trauma Patients



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