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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.�
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 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:
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 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.
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