Multicentre prospective validation of use of the Canadian C-Spine Rule by triage nurses in the emergency department

Accuracy of the Canadian C-spine rule and NEXUS to screen for clinically important cervical spine injury in patients following blunt trauma: a systematic review

“…20 The sensitivity of the Canadian C-spine rule ranged from 0.90 to 1.0, while the specificity ranged from 0.01 to 0.77 ( Figure 2). The Canadian C-spine rule had a low rate of false negative results (0%-0.11%), 24 and imaging rates would have been reduced by an average of 42.0% (0.6%-75.4%) without missing a clinically important cervical spine injury. Figure 3 shows the prevalence of clinically important injury reported in each study, positive and negative likelihood ratios and the post-test probability given a positive and negative test result.…”

“…In the 8 studies that used different reference tests, patients who did not undergo imaging were followed up with either the 14-day proxy 2,13,19,22,23,26 or the 21-day surveillance strategy. 19,21,24 With the 14-day proxy method, patients are contacted by a registered nurse 14 days after discharge and asked 8 questions about pain and return to function. A positive response to these questions resulted in patients being asked to return to hospital for imaging investigations.…”

“…Of the 9 studies that assessed the Canadian Cspine rule, 4 were prospective studies 2,13,21,23 that aimed to assess the rule in its entirety; 4 prospectively applied a modified version of the rule; 19,22,24,25 and 1 was a retrospective study. 20 The sensitivity of the Canadian C-spine rule ranged from 0.90 to 1.0, while the specificity ranged from 0.01 to 0.77 ( Figure 2).…”

Prehospital Use of Cervical Collars in Trauma Patients: A Critical Review

“…[199][200][201] Further, the CCR can be used with similar accuracy and reliability by triage nurses in the ED and paramedics in the prehospital setting. [202][203][204] Education of prehospital personnel in clinical clearance of the cervical spine has a large potential for improving management, with an estimated 40% reduction in cervical spine immobilization (and subsequent radiological examinations). 43,197 Radiological investigations are often deemed unnecessary for conscious patients without symptoms, neurological deficits, or distracting injuries and that have a full range of motion upon functional examination.…”

Clinical Prediction and Decision Rules in Neurosurgery

“…Publications include details of the derivation of the rule, 49 internal 28 and external validation, 53,54 as well as studies on the impact of the rule on clinical practice. 40,55,56 Although only some of these rules were fully validated, as outlined previously, most comparative analyses have shown very little difference among them in terms of predictive value.…”