Canadian C-spine Rule and the National Emergency X-Radiography Utilization Low-Risk Criteria for C-spine radiography in young trauma patients.
OBJECTIVE
The Canadian C-spine (cervical spine) Rule (CCR) and the National Emergency X-Radiography Utilization Low-Risk Criteria (NLC) are criteria designed to guide C-spine radiography in trauma patients. It is unclear how these 2 rules compare with young children.


METHODS
This study retrospectively examined case-matched trauma patients 10 years or younger. Two cohorts were identified-cohort A where C-spine imaging was performed and cohort B where no imaging was conducted. The CCR and NLC criteria were then applied retrospectively to each cohort.


RESULTS
Cohort A contained 125 cases and cohort B with 250 cases. Seven patients (3%) had significant C-spine injuries. In cohort A, NLC criteria could be applied in 108 (86.4%) of 125 and CCR in 109 (87.2%) of 125. National Emergency X-Radiography Utilization Low-Risk Criteria suggested that 70 (58.3%) cases required C-spine imaging compared to 93 (76.2%) by CCR. National Emergency X-Radiography Utilization Low-Risk Criteria missed 3 C-spine injuries, and CCR missed one. In cohort B, NLC criteria could be applied in 132 (88%) of 150 and CCR in 131 (87.3%) of 150. The NLC criteria identified 8 cases and CCR identified 13 cases that would need C-spine radiographs. Fisher's 2-sided Exact test demonstrated that CCR and NLC predictions were significantly different (P = .002) in both cohorts. The sensitivity of CCR was 86% and specificity was 94%, and the NLC had a sensitivity of 43% and a specificity of 96%.


CONCLUSIONS
Although CCR and NLC criteria may reduce the need for C-spine imaging in children 10 years and younger; they are not sensitive or specific enough to be used as currently designed.
Department of Surgery, Section of Pediatric Surgery, The University of Michigan Medical School and The CS Mott Children's Hospital, Ann Arbor, MI 48109, USA. pehrlich@med.umich.edu
Peter F
PF
Ehrlich
Christopher
C
Wee
Robert
R
Drongowski
Ankur R
AR
Rana
D000367:Age Factors; D002170:Canada; D016022:Case-Control Studies; D002574:Cervical Vertebrae / Q000000981:diagnostic imaging* / Q000293:injuries; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D003661:Decision Support Techniques; D003951:Diagnostic Errors / Q000517:prevention & control*; D004630:Emergencies; D006801:Humans; D007223:Infant; D019838:Neck Injuries / Q000000981:diagnostic imaging*; D011859:Radiography / Q000592:standards / Q000706:statistics & numerical data; D012189:Retrospective Studies; D012306:Risk; D012680:Sensitivity and Specificity; D013119:Spinal Cord Injuries / Q000000981:diagnostic imaging; D016103:Spinal Fractures / Q000000981:diagnostic imaging; D019564:Unnecessary Procedures