Validation of the Canadian c-spine rule in the UK emergency department setting.
OBJECTIVE
To determine the potential of the Canadian Cervical Spine Rule (CCR) to safely reduce the number of cervical spine (c-spine) radiographs performed in the UK emergency department setting.


METHODS
The study was conducted in two UK emergency departments with a combined annual attendance of >150,000 adult patients. Over the 24 month trial period, 148 doctors were provided training in the use of the CCR and instructed to assess eligible patients presenting with potential c-spine injury. Doctors were instructed to manage patients according to existing practice and not according to the decision obtained from the rule. A subsample of patients was reassessed by a second doctor to test interobserver reliability.


RESULTS
A total of 1420 patients were enrolled in the study (50.4% male). 987 (69.5%) had c-spine radiography performed, with 8 (0.6%) having a c-spine injury. If the decision for radiography had been made according to the outcome of the CCR, only 815 (57.4%) would have had c-spine radiography and all 8 abnormal cases would have undergone imaging. Doctors were comfortable using the rule in 91% of cases. Interobserver reliability was good (κ=0.75 95% CI 0.44 to 1.06).


CONCLUSIONS
The CCR can be applied successfully in the UK. Had the CCR been in use during the study period, a 17.4% reduction in radiography could have been achieved without compromising patient care.
Emergency Department, Nottingham University Hospitals NHS Trust, Queens Medical Centre Campus, Derby Road, Nottingham NG7 2UH, UK. frank.coffey@nottingham.ac.uk
Frank
F
Coffey
Susanne
S
Hewitt
Ian
I
Stiell
Nick
N
Howarth
Phil
P
Miller
Cathy
C
Clement
Paul
P
Emberton
Abdul
A
Jabbar
D000208:Acute Disease; D000328:Adult; D002574:Cervical Vertebrae / Q000000981:diagnostic imaging / Q000293:injuries*; D003661:Decision Support Techniques; D004635:Emergency Medicine / Q000379:methods*; D004636:Emergency Service, Hospital; D005260:Female; D006801:Humans; D008297:Male; D015588:Observer Variation; D011859:Radiography; D015203:Reproducibility of Results; D006113:United Kingdom; D014949:Wounds, Nonpenetrating / Q000175:diagnosis