title: Canadian Cervical Spine rule compared with computed tomography: a prospective analysis.
abstract: BACKGROUND
  The Canadian cervical spine rule (CCS) has been found to be an effective tool to determine the need for radiographic evaluation of the cervical spine (c-spine) incorporating both clinical findings and mechanism. Previously, it has been validated only through clinical follow-up or selective use of X-rays. The purpose of this study was to validate it using computed tomography (CT) as the gold standard to identify fractures.
  
  
  METHODS
  Prospective evaluation was performed on 3,201 blunt trauma patients who were screened by CCS and were compared with a complete c-spine CT. CSS positive indicated at least one positive clinical or mechanism finding, whereas CT positive indicated presence of a fracture.
  
  
  RESULTS
  There were 192 patients with c-spine fractures versus 3,009 without fracture on CT. The fracture group was older (42.7 ± 19.0 years vs. 37.8 ± 17.5 years, p = 0.0006), had a lower Glasgow Coma Scale score (13.8 ± 4.2 vs. 14.4 ± 4.3, p < 0.0001), and lower systolic blood pressure (133.3 ± 23.8 mm Hg vs. 139.5 ± 23.1 mm Hg, p = 0.0023). The sensitivity of CCS was 100% (192/192), specificity was 0.60% (18/3009), positive predictive value was 6.03% (192/3183), and negative predictive value was 100% (18/18). Logistic regression identified only 8 of the 19 factors included in the CCS to be independent predictors of c-spine fracture.
  
  
  CONCLUSIONS
  CCS is very sensitive but not very specific to determine the need for radiographic evaluation after blunt trauma. Based on this study, the rule should be streamlined to improve specificity while maintaining sensitivity.
authors.affiliation: Division of Trauma, Critical Care, and Emergency General Surgery, Department of Surgery, Virginia Commonwealth University Medical Center, Richmond, Virginia, USA. tmduane@vcu.edu
authors.forename: Therèse M
authors.initials: TM
authors.lastname: Duane
authors.forename: Sean P
authors.initials: SP
authors.lastname: Wilson
authors.forename: Julie
authors.initials: J
authors.lastname: Mayglothling
authors.forename: Luke G
authors.initials: LG
authors.lastname: Wolfe
authors.forename: Michel B
authors.initials: MB
authors.lastname: Aboutanos
authors.forename: James F
authors.initials: JF
authors.lastname: Whelan
authors.forename: Ajai K
authors.initials: AK
authors.lastname: Malhotra
authors.forename: Rao R
authors.initials: RR
authors.lastname: Ivatury
mesh_terms: D000328:Adult; D000465:Algorithms; D002170:Canada; D002574:Cervical Vertebrae / Q000000981:diagnostic imaging* / Q000293:injuries*; D003661:Decision Support Techniques; D004632:Emergency Medical Services / Q000592:standards; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012307:Risk Factors; D012680:Sensitivity and Specificity; D016103:Spinal Fractures / Q000175:diagnosis* / Q000000981:diagnostic imaging; D014057:Tomography, X-Ray Computed; D014194:Traumatology / Q000592:standards*; D014949:Wounds, Nonpenetrating / Q000000981:diagnostic imaging* / Q000453:epidemiology; D055815:Young Adult