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:

• Age older than 65 years

• Mechanism of injury considered dangerous

• 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 for 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:

• Simple rear-end motor vehicle collision

• Patient ambulatory at any time since injury

• Delayed onset of neck pain

• Patient in sitting position in emergency department

• Absence of midline cervical spine tenderness

If none of these low-risk factors is present, the patient is at risk for 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.