Does applying the Canadian Cervical Spine rule reduce cervical spine radiography rates in alert patients with blunt trauma to the neck? A retrospective analysis.
BACKGROUND
A cautious outlook towards neck injuries has been the norm to avoid missing cervical spine injuries. Consequently there has been an increased use of cervical spine radiography. The Canadian Cervical Spine rule was proposed to reduce unnecessary use of cervical spine radiography in alert and stable patients. Our aim was to see whether applying the Canadian Cervical Spine rule reduced the need for cervical spine radiography without missing significant cervical spine injuries.


METHODS
This was a retrospective study conducted in 2 hospitals. 114 alert and stable patients who had cervical spine radiographs for suspected neck injuries were included in the study. Data on patient demographics, high risk & low risk factors as per the Canadian Cervical Spine rule and cervical spine radiography results were collected and analysed.


RESULTS
28 patients were included in the high risk category according to the Canadian Cervical Spine rule. 86 patients fell into the low risk category. If the Canadian Cervical Spine rule was applied, there would have been a significant reduction in cervical spine radiographs as 86/114 patients (75.4%) would not have needed cervical spine radiograph. 2/114 patients who had significant cervical spine injuries would have been identified when the Canadian Cervical Spine rule was applied.


CONCLUSIONS
Applying the Canadian Cervical Spine rule for neck injuries in alert and stable patients would have reduced the use of cervical spine radiographs without missing out significant cervical spine injuries. This relates to reduction in radiation exposure to patients and health care costs.
Department of Orthopaedics, Glan Clwyd Hospital, Bodelwyddan, UK. ulfinr@yahoo.com
Ulfin
U
Rethnam
Rajam
R
Yesupalan
Giri
G
Gandham
D000368:Aged; D000369:Aged, 80 and over; D002170:Canada / Q000453:epidemiology; D002574:Cervical Vertebrae / Q000000981:diagnostic imaging; D015897:Comorbidity; D003422:Critical Care / Q000706:statistics & numerical data*; D003661:Decision Support Techniques; D005260:Female; D006801:Humans; D008297:Male; D019838:Neck Injuries / Q000000981:diagnostic imaging* / Q000453:epidemiology*; D018579:Patient Selection; D011859:Radiography; D015203:Reproducibility of Results; D012189:Retrospective Studies; D018570:Risk Assessment / Q000592:standards / Q000706:statistics & numerical data*; D012307:Risk Factors; D012680:Sensitivity and Specificity; D013124:Spinal Injuries / Q000000981:diagnostic imaging* / Q000453:epidemiology*; D014949:Wounds, Nonpenetrating / Q000000981:diagnostic imaging* / Q000453:epidemiology*