Clearing the pediatric cervical spine springerlink. The canadian cspine rule versus the nexus lowrisk criteria. Of the 9 studies that assessed the canadian cspine rule, 4 were prospective studies 2, 21, 23 that aimed to assess the rule in its entirety. The outofhospital validation of the canadian cspine.
Service providers ambulance services, major trauma centres, trauma units and district general hospitals train staff in using the canadian c. For alert glasgow coma scale 15 and stable trauma patients where cervical spine injury is a concern 1. Zuruck zum zitat stiell ig et al 2003 comparative validation of the canadian cspine rule and the nexus lowrisk criteria in alert and stable trauma patients. The canadian cspine rule for radiography in alert and. Ian stiell wrote a paper 1 about the uptake and reallife implementation of his four clinical decision rules or as we prefer to call them, clinical decision tools. Further, the incidence of pediatric cervical spine injuries varies by age 1. The boringem team hypothesizes that the ease of use may be greatly affected by the complexity of a rule itself i.
Application of the canadian cspine rule and nexus low. The canadian c spine rule was developed from high quality research and found to be highly sensitive 98100%, reliable, clinically applicable, simple to use, and superior to both clinical judgement and similar decision rules. Implementation of the canadian cspine rule the safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Hier wurden insgesamt 8924 patienten eingeschlossen. Canadian cspine rule cervical spine fractures youtube. The canadian cspine rules ccr and the national emergency xradiography utilization group nexus criteria allow clinicians to clear lowrisk. Nov 06, 2012 there is uncertainty about the optimal approach to screen for clinically important cervical spine c spine injury following blunt trauma. What are the canadian cspine rules ccr for cervical. The canadian cspine rule ccr was developed to help physicians determine which trauma patients need cspine imaging. Canadian cspine rule study for alert and stable trauma. One of the two widely adopted and evidence based decision rules is used in the initial evaluation of the cervical spine following trauma.
Overview and comparison of nexus and canadian c spine rules difficult to determine exactly what type of injuries could interfere with a thorough physical exam or distract a patient from other injuries. I suspect the ottawa sah rule may be destined to join the ranks of stiell et als other canadian exports the canadian ct head rule, canadian cspine rule, and ottawa footankleknee rules and decided that i needed a way to remember it. If it is not available, a threeview spine xray is recommended anteroposterior, odontoid. However, there is literature to suggest caution applying nexus to patients 65 years of age, as the sensitivity may be as low as 6684 %. I argue that we should not send patients to imaging unless we have used the nexus rule and then added the canadian c spine rule to the sequence. Abstract background the canadian cspine cervicalspine rule ccr and the national emergency xradiography utilization study nexus lowrisk criteria nlc are decision rules to guide the use of cervicalspine radiography in patients with trauma.
Sep 19, 2016 blunt cervical spine injury in the pediatric population is uncommon, present in only 12 % of all pediatric trauma admissions 2, 3. In this episode, i discuss the diagnosis of c spine injuries. Accuracy of the canadian cspine rule and nexus to screen for. Over the 24 month trial period, 148 doctors were provided training in the use. Canadian cspine rule emergency medicine research ottawa. For many people, this has lead to barriers for adoption of the canadian cspine rules. Usethe ottawa knee rules okr to exclude fractures and reduce unnecessary imaging. Identifying patients at low risk for cervical spine injury. Douglas mcknight, robert brison, howard lesiuk, catherine m. Implementation of the canadian c spine rule the safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Stiell, md, msc tammy beaudoin, chim justin maloney, md andrew r. Overview and comparison of nexus and canadian cspine rules difficult to determine exactly what type of injuries could interfere with a thorough physical exam or distract a patient from other injuries.
The canadian cspine rule versus the nexus lowrisk criteria in patients with trauma. Ian stiell and his research team at the ottawa hospital research institute and the university of ottawa. In cross validation analysis, the canadian cspine rule had 100% sensitivity and 42. Validation of the canadian cspine rule in the uk emergency. The outofhospital validation of the canadian c spine rule by paramedics christian vaillancourt, md, msc ian g. A letter to the editor is presented about the slow implementation of the canadian c spine rule in prehospital research. It is unclear how the two decision rules compare in. Ccr is highly sensitive for csi, with the majority of studies finding it catches 99100% of these types of injuries. Define whether any high risk factors are present such as age. What the quality statement means for different audiences. We will conduct a retrospective casecontrol study to include 550 children with csi. Study design prospective cohort study of blunt trauma patients from 10 canadian eds community and university hospitals, where each pt was evaluated for 20 standardized clinical findings before radiographs 3 views.
A universal reference library, comprising the arts and. Canadian cspine rule university of british columbia. The canadian c spine cervical spine rule ccr and the national emergency xradiography utilization study nexus lowrisk criteria nlc are decision rules to guide the use of cervical spine radiography in patients with trauma. Most are immobilized with board and cervical collar, necessitating a. Implementation of the canadian cspine rule full text view. Canadian c spine rules are a set of guidelines that help a clinician decide if cervical spine imaging is not appropriate for a trauma patient in the emergency department. The rules are derived from original research and incorporate three or more variables from the history, examination, or simple tests. Greenberg, iain macphail, mark reardon, james worthington, richard verbeek, jonathan dreyer, daniel cass, michael schull, laurie morrison. Criteria ottawa knee rules xray for acute injury of the knee. Applying the canadian c spine rule would allow healthcare providers to safely decrease the need for imaging. Methods we aimed to evaluate retrospectively the application of these recommendations in our emergency department. Aim to determine the potential of the canadian cervical spine rule ccr to safely reduce the number of cervical spine cspine radiographs performed in the uk emergency department setting.
Advise patients to seek followup care if their pain or ability to bear weight has not improved in five to seven days. An online survey to determine current awareness, knowledge, and use of the canadian cervical spine rule cspine rule by bc physical therapists was undertaken january 28may 15 20. This study examined whether the theory of planned behaviour tpb could help explain the inconsistent results between the successful canadian c spine rule ccr implementation study and unsuccessful canadian ct head rule cchr implementation. The outofhospital validation of the canadian cspine rule. To optimize care of acute traumatic neck pain patients by bc physiotherapists, specifically with respect to appropriate referral for medical imaging. Nexus this was a prospective study put forth to validate a rule for the decision whether to xray in low risk patients. The canadian cspine rule ccr is a clinical decision or prediction rule developed in canada that is used to detect acute cervical spine injury. The ottawa rules are a set of clinical decision rules developed by dr. Unlike the canadian cspine rule ccr, nexus criteria does not have age cutoffs and is theoretically applicable to all patients 1 year of age.
The canadian cspine rule for imaging of the cervical spine was developed for use by physicians. Ottawa neck rules pdf for alert gcs15 and stable trauma patients where cervical spine injury is a concern. Theory of planned behaviour can help understand processes. The canadian ct head injurytrauma rule clears head injury without imaging. Canadian cspine rule ottawa hospital research institute. Canadian cspine rules are a set of guidelines that help a clinician decide if cervical spine imaging is not appropriate for a trauma patient in the emergency department.
Anton, md paul bradford, md ed cain, md andrew travers, md, msc matt stempien, md martin lees, md doug munkley, md erica battram, rn jane banek, chim george a. Canadian cspine rule study for alert and stable trauma patients. Guidelines the canadian cspine rule v the nexus lowrisk criteria in patients with trauma. Sep 01, 2006 this work will be conducted within the pediatric emergency care applied research network pecarn, a multicentered, collaborative pediatric emergency medicine research network.
Evaluation and stabilization of the athlete with possible. Implementation of the canadian cspine rule full text. Dec 05, 2014 the canadian c spine rules ccr is an assessment tool used to rule out cervical spine injury in lowrisk patients, obviating the need for radiography. Commentary more than 1 million patients with possible cervical spine injury secondary to recent blunt trauma present to north american eds annually 1. Ian stiell, professor in the department of emergency medicine at the university of ottawa, discussing the assessment of a patient using the canadian c spine rules. The imaging modality of choice is computed tomography ct. The rules have been demonstrated to decrease unnecessary diagnostic imaging and emergency room wait times which enhances patient comfort and reduces health care costs.
Pediatric emergency care applied research network pecarn. A clinical decision rule to determine the need for diagnostic imaging for alert and stable trauma patients gcs 15 with neck pain. Canadian cspine rule of the 9 studies that assessed the canadian cspine rule, 4 were prospective studies2,21,23 that aimed to assess the rule in its entirety. Methods the study was conducted in two uk emergency departments with a combined annual attendance of 150 000 adult patients. Pdf the use of the canadian cspine rule to reduce the. The canadian c spine rule ccr and the national emergency xradiography utilization study nexus low criteria are well accepted as guide to help physician in case of cervical blunt trauma. Evidencebased information on guidelines on cervical spine injury from hundreds of trustworthy sources for health and social care.
C spine is a little program that lets you put the ottawa rules for the cervical column. I gave a talk the other day on clearing cspines, with prezi linked here. The clinical decision rule is reportedly designed to hasten cervical spine clearance and limit unnecessary radiography in emergency departments. Clinical decision rules cdrs can be an effective tool for knowledge translation in emergency medicine, but their implementation is often a challenge. Applying the canadian cspine rule would allow healthcare providers to safely decrease the need for imaging. Accuracy of the canadian cspine rule and nexus to screen. Pdf validation of the canadian cspine rule in the uk. The goal of the canadian cspine rule is to rule out cervical spine fractures after blunt trauma to the head.
The results of the survey informed the need for and subsequent design of learning resources and tools to increase awareness and use of the c. The cervical spine rule will permit physicians to standardize care of alert, stable trauma patients, to rapidly clear the cervical spine, and to be much more selective in the use of cervical spine radiography without jeopardizing patient care. Mechanism considered dangerous fall from 3 feet, axial load injury c. The canadian c spine rule ccr was developed to help physicians determine which trauma patients need c spine imaging. For those imaged, standard diagnostic imaging may have included plain radiography, oblique views. If i use this rule, will i miss a serious c spine injury. An online survey to determine current awareness, knowledge, and use of the canadian cervical spine rule cspine rule by bc physical therapists was undertaken january 28 may 15, 20. The paper concludes that future research should identify implementation barriers and explore strategies to achieve better knowledge uptake in the ed. Evidencebased information on canadian c spine rules from hundreds of trustworthy sources for health and social care.
Listing a study does not mean it has been evaluated by the u. It is unclear how the two decision rules compare in terms of clinical performance. Validation of the canadian c spine rule in the uk emergency department setting frank coffey,1 susanne hewitt,2 ian stiell,3 nick howarth,2 phil miller,1 cathy clement,5 paul emberton,4 abdul jabbar1 abstract aim to determine the potential of the canadian cervical spine rule ccr to safely reduce the number of cervical. If any of these is positive, patient should have imaging 3. C spine rule versus the nexus lowrisk criteria in patients with trauma. Conclusion we have derived the canadian cspine rule, a highly sensitive decision rule for use of cspine radiography in alert and stable trauma patients. Aim to determine the potential of the canadian cervical spine rule ccr to safely reduce the number of cervical spine c spine radiographs performed in the uk emergency department setting. It is the dedication of healthcare workers that will lead us through this crisis.
The canadian cspine cervicalspine rule ccr and the national emergency xradiography utilization study nexus lowrisk criteria nlc are decision rules to guide the use of cervicalspine radiography in patients with trauma. The canadian cspine rule for radiography in alert and stable trauma patients. The canadian cspine rule more accurately identified cervicalspine injury in trauma than the nexus lowrisk criteria pdf. The canadian cspine rule was created in response to increased costs associated with nonessential radiography 98% and increased patient wait times while immobilized to back boards. The canadian c spine rule for alert glasgow coma scale score 15 and stable trauma patients for whom cervical spine injury is a concern, including patients with either posterior neck pain with any blunt mechanism of injury or no neck pain but some visible injury above the clavicles. Over the 24 month trial period, 148 doctors were provided. If this is the case, an xray of the cervical spine. If prospectively validated in other cohorts, this rule has the potential to significantly reduce practice variation and inefficiency in. Ankle rules for ankle injury radiography a an ankle xray series is only required if there is any pain in malleolar zone and any of these findings. Still always be careful not to induce unneeded fear into the patient but still absolutely worth knowing well. Guidelines the canadian cspine rule v the nexus low. To determine the potential of the canadian cervical spine rule ccr to safely reduce the number of cervical spine c spine radiographs performed in the uk emergency department setting. Canadian cspine rules stielet al 2001 another acceptable decision rule to evaluate a potentially spine injured patient 1.
Staff radiologists interpreting the radiographs were provided with routine clinical information but not the contents of the data form. The canadian cspine rule project department of physical. The canadian cspine rule helps guide clinicians as to the indications for cervical xrays for alert and stable adults who have sustained recent blunt trauma and are at risk for clinically important cervical spine injury. Background thecanadiancspinecervicalspine rule ccrandthenationalemergencyxradi ography utilization study nexus lowrisk criteria nlc are decision rules to guide the use of cervicalspine radiography in patients with trauma.
1213 1162 264 1453 15 409 1228 1218 177 783 793 48 288 904 561 631 706 709 982 1399 407 280 525 1287 1117 399 455 123 1147 926 1416 993