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How accurate is the Canadian C-spine rule for the detection of clinically significant cervical spine injuries?
ABSTRACT
BACKGROUND: Current use of cervical spine (C-spine) radiography for alert and stable trauma patients is highly variable and expensive in practice. A recent clinical decision rule to identify low-risk patients was accurate in distinguishing those who would not need radiography (high sensitivity) but would result in many patients being unnecessarily imaged (low specificity).1 The originators of the Ottawa Ankle and Knee rules have created a decision rule for use of C-spine radiography.
POPULATION STUDIED: The study enrolled patients 16 years and older who sustained acute blunt trauma to the head or neck and presented to an emergency department (ED) of 10 large Canadian hospitals. Patients had to be completely alert with normal vital signs. They either had to report neck pain or be nonambulatory with visible injury above the clavicles after a dangerous mechanism of injury. Patients were not studied if they were injured more than 48 hours before presentation, were returning for reassessment of the same injury, were pregnant, or had penetrating trauma, acute paralysis, or known vertebral disease.
STUDY DESIGN AND VALIDITY: This was a prospective cohort study in which physicians determined 20 standardized clinical findings from the history and physical examination. The physician would then decide whether to obtain C-spine radiography; if no X-ray was obtained, a structured telephone interview 14 days later determined whether a clinically important C-spine injury had taken place. Clinical findings were then analyzed for their association with significant C-spine injuries. Although the study attempted to enroll consecutive patients, 3281 of 12,782 eligible patients were not enrolled for unclear reasons, and 577 patients could not be contacted by telephone for follow-up.
OUTCOMES MEASURED: The primary outcome measure was clinically important C-spine injury, defined as a fracture, dislocation, or ligamentous instability demonstrated by diagnostic imaging.
RESULTS: Approximately 69% of patients underwent C-spine radiography, and 31% underwent the 14-day follow-up phone interview. A total of 151 (1.7%) were determined to have a clinically important C-spine injury. No patients who did not undergo radiography were found to have important injuries 14 days later.
The Canadian C-Spine rule shows promise as an aid to decide whether to use C-spine radiography in alert stable patients with head or neck injuries. It demonstrates high sensitivity and reasonable specificity. However, the rule needs to be validated in other populations before accepting it as the standard of care.
ABSTRACT
BACKGROUND: Current use of cervical spine (C-spine) radiography for alert and stable trauma patients is highly variable and expensive in practice. A recent clinical decision rule to identify low-risk patients was accurate in distinguishing those who would not need radiography (high sensitivity) but would result in many patients being unnecessarily imaged (low specificity).1 The originators of the Ottawa Ankle and Knee rules have created a decision rule for use of C-spine radiography.
POPULATION STUDIED: The study enrolled patients 16 years and older who sustained acute blunt trauma to the head or neck and presented to an emergency department (ED) of 10 large Canadian hospitals. Patients had to be completely alert with normal vital signs. They either had to report neck pain or be nonambulatory with visible injury above the clavicles after a dangerous mechanism of injury. Patients were not studied if they were injured more than 48 hours before presentation, were returning for reassessment of the same injury, were pregnant, or had penetrating trauma, acute paralysis, or known vertebral disease.
STUDY DESIGN AND VALIDITY: This was a prospective cohort study in which physicians determined 20 standardized clinical findings from the history and physical examination. The physician would then decide whether to obtain C-spine radiography; if no X-ray was obtained, a structured telephone interview 14 days later determined whether a clinically important C-spine injury had taken place. Clinical findings were then analyzed for their association with significant C-spine injuries. Although the study attempted to enroll consecutive patients, 3281 of 12,782 eligible patients were not enrolled for unclear reasons, and 577 patients could not be contacted by telephone for follow-up.
OUTCOMES MEASURED: The primary outcome measure was clinically important C-spine injury, defined as a fracture, dislocation, or ligamentous instability demonstrated by diagnostic imaging.
RESULTS: Approximately 69% of patients underwent C-spine radiography, and 31% underwent the 14-day follow-up phone interview. A total of 151 (1.7%) were determined to have a clinically important C-spine injury. No patients who did not undergo radiography were found to have important injuries 14 days later.
The Canadian C-Spine rule shows promise as an aid to decide whether to use C-spine radiography in alert stable patients with head or neck injuries. It demonstrates high sensitivity and reasonable specificity. However, the rule needs to be validated in other populations before accepting it as the standard of care.
ABSTRACT
BACKGROUND: Current use of cervical spine (C-spine) radiography for alert and stable trauma patients is highly variable and expensive in practice. A recent clinical decision rule to identify low-risk patients was accurate in distinguishing those who would not need radiography (high sensitivity) but would result in many patients being unnecessarily imaged (low specificity).1 The originators of the Ottawa Ankle and Knee rules have created a decision rule for use of C-spine radiography.
POPULATION STUDIED: The study enrolled patients 16 years and older who sustained acute blunt trauma to the head or neck and presented to an emergency department (ED) of 10 large Canadian hospitals. Patients had to be completely alert with normal vital signs. They either had to report neck pain or be nonambulatory with visible injury above the clavicles after a dangerous mechanism of injury. Patients were not studied if they were injured more than 48 hours before presentation, were returning for reassessment of the same injury, were pregnant, or had penetrating trauma, acute paralysis, or known vertebral disease.
STUDY DESIGN AND VALIDITY: This was a prospective cohort study in which physicians determined 20 standardized clinical findings from the history and physical examination. The physician would then decide whether to obtain C-spine radiography; if no X-ray was obtained, a structured telephone interview 14 days later determined whether a clinically important C-spine injury had taken place. Clinical findings were then analyzed for their association with significant C-spine injuries. Although the study attempted to enroll consecutive patients, 3281 of 12,782 eligible patients were not enrolled for unclear reasons, and 577 patients could not be contacted by telephone for follow-up.
OUTCOMES MEASURED: The primary outcome measure was clinically important C-spine injury, defined as a fracture, dislocation, or ligamentous instability demonstrated by diagnostic imaging.
RESULTS: Approximately 69% of patients underwent C-spine radiography, and 31% underwent the 14-day follow-up phone interview. A total of 151 (1.7%) were determined to have a clinically important C-spine injury. No patients who did not undergo radiography were found to have important injuries 14 days later.
The Canadian C-Spine rule shows promise as an aid to decide whether to use C-spine radiography in alert stable patients with head or neck injuries. It demonstrates high sensitivity and reasonable specificity. However, the rule needs to be validated in other populations before accepting it as the standard of care.