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.
Ehrlich
Peter F
PF
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
Wee
Christopher
C
Drongowski
Robert
R
Rana
Ankur R
AR
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