Canadian C-Spine Rule
The Canadian C-Spine Rules (CCR) is an assessment tool used to rule out cervical spine injury in low-risk patients, obviating the need for radiography. [1, 2, 3, 4, 5, 6]
Step 1
Is there any high-risk factor that mandates radiography? These include the following:
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Age older than 65 years
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Mechanism of injury considered dangerous
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Numbness or tingling present in the extremities
A dangerous mechanism of injury would be, for example, a fall from an elevation of 3 feet or higher, a bicycle collision, an axial load to the head (eg, resulting from a dive into an empty swimming pool), or a motor vehicle collision involving high speed, rollover, or ejection.
If the answer to any of these is yes, the patient is at risk of having a cervical spine injury and neck radiography should be performed. Otherwise, proceed to step 2.
Step 2
Are there any low-risk factors that indicate safe assessment of range of motion? They are as follows:
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Simple rear-end motor vehicle collision
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Patient ambulatory at any time since injury
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Delayed onset of neck pain
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Patient in sitting position in emergency department
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Absence of midline cervical spine tenderness
If none of these low-risk factors is present, the patient is at risk of having a cervical spine injury, and neck radiography should be performed. Otherwise, proceed to step 3.
Step 3
Is the patient able to actively rotate his or her neck 45° left and right?
If no, the patient is at risk for having a cervical spine injury and neck radiography should be performed. If yes, radiography is not performed.