Canadian C-Spine Rule
Which alert, stable trauma patients need cervical spine imaging.
Inputs
2 of 3High-risk factor (age ≥ 65, dangerous mechanism, or limb paresthesias)
Any low-risk factor (simple rear-end crash, sitting in ED, walking at any time, delayed neck pain, no midline tenderness)
Able to actively rotate the neck 45° left and right
When to use
- Alert (GCS 15), stable adults with head or neck trauma.
Pearls and pitfalls
- More sensitive and specific than NEXUS in head-to-head comparison.
- Not for age under 16, GCS below 15, unstable vitals, or known vertebral disease.
Why use
Safely avoids many cervical spine images.
High-risk factor → image; no low-risk factor → image; unable to rotate neck 45° both ways → image; otherwise no imaging