- Neurologic Deficit
- Spinal tenderness
- Altered mental status
- Intoxication
- Distracting injury
If none of the above, the C spine can be cleared clinically.
Definition of Neurologic deficit / AMS:
- GCS ≤ 14
- Disorientation to person, place, time, or events
- Inability to remember 3 objects at 5 minutes
- Delayed or inappropriate response to external stimuli
- Any focal deficit on motor or sensory examination.
Definition of intoxicated:
- Recent history of intoxication or intoxicating ingestion
- Intoxication on physical examination or blood alcohol level > 0.08 mg/dL
Definition of distracting injury:
- Long bone fracture
- Visceral injury requiring surgical consultation
- Large laceration, degloving injury, or crush injury
- Large burns
- Any injury producing acute functional impairment or limiting the ability to appreciate other injuries
Steil et al. The Canadian C-Spine Rule versus the NEXUS Low-Risk Criteria in Patients with Trauma. NEJM. 2003. 349(26):2510-8.
- Prospective multicenter cohort of 8283 patients
- CCR 95% sensitive
- NEXUS 91% sensitive
- Conclusion: CCR superior to NEXUS
Hoffman JR et al. Selective cervical spine radiography in blunt trauma: methodology of the National Emergency X-Radiography Utilization Study (NEXUS). Ann Emerg Med. 1998; 32(4): 461-9.