🦴 Canadian C-Spine Rule
UseReduce unnecessary C-spine imaging in alert, stable patients.
StrataPresence of high-risk factors or inability to rotate 45° indicates imaging; successful low-risk rotation clea…
LimitsDo not apply if GCS <15, unstable vitals, paralysis, or age/mechanism… · More specific than NEXUS but still requires careful high-/low-risk as… · When assessment is unreliable, default to imaging.
SourceStiell IG, et al. JAMA 2001. doi:10.1001/jama.286.15.1841 (Canadian C-Spine Rule)
This-shift next steps
After scoring: open the scene pack, peer scores, and the matching pathway. Local reference — no HIS write.
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Methodology · worked example, guidelines & full notes
Applies to alert (GCS 15), stable trauma patients.
When to use
Reduce unnecessary C-spine imaging in alert, stable patients.
How it works
Image if any high-risk factor is present; otherwise, if a low-risk factor permits safe assessment of rotation, clear if the patient can rotate the neck 45° each way.
Key points
- Applies to alert (GCS 15), stable trauma patients.
- Very high sensitivity for significant injury.
- More specific than NEXUS, reducing imaging.
References
Worked calculation
The values below come from this tool's own example placeholders and are computed server-side with the formula shown on this page, so the arithmetic can be checked quickly. It demonstrates how to substitute values only — it is not clinical advice and not a real case.
| Any high-risk factor (age ≥ 65, dangerous mechanism, or paraesthesias in extremities) | No |
|---|---|
| Any low-risk factor allowing safe assessment (simple rear-end MVC, sitting in ED, ambulatory, delayed neck pain, or no midline tenderness) | Yes |
| Able to actively rotate neck 45° left and right | Yes |
→ResultNo imaging needed — clinically clear
- Logic：High-risk factor → image. Otherwise, if a low-risk factor permits, test active rotation; full 45° each way clears the spine.
| Any high-risk factor (age ≥ 65, dangerous mechanism, or paraesthesias in extremities) | Yes |
|---|---|
| Any low-risk factor allowing safe assessment (simple rear-end MVC, sitting in ED, ambulatory, delayed neck pain, or no midline tenderness) | No |
| Able to actively rotate neck 45° left and right | No / not tested |
→ResultImaging indicated
- Logic：High-risk factor → image. Otherwise, if a low-risk factor permits, test active rotation; full 45° each way clears the spine.
Verification & sources · governance
FAQ
Frequently asked questions
- Does Canadian C-Spine Rule upload patient data? Where is it calculated?
- Calculation runs locally in the browser; inputs and results are not uploaded. For licensed clinicians only; interpret with history, investigations and local protocols — not a diagnosis or prescription.
- How is Canadian C-Spine Rule calculated in practice? Can you show a worked example?
- Inputs: Any high-risk factor (age ≥ 65, dangerous mechanism, or paraesthesias in extremities) No, Any low-risk factor allowing safe assessment (simple rear-end MVC, sitting in ED, ambulatory, delayed neck pain, or no midline tenderness) Yes, Able to actively rotate neck 45° left and right Yes → Result: Result No imaging needed — clinically clear（Logic: High-risk factor → image. Otherwise, if a low-risk factor permits, test active rotation; full 45° each way clears the spine.） Inputs: Any high-risk factor (age ≥ 65, dangerous mechanism, or paraesthesias in extremities) Yes, Any low-risk factor allowing safe assessment (simple rear-end MVC, sitting in ED, ambulatory, delayed neck pain, or no midline tenderness) No, Able to actively rotate neck 45° left and right No / not tested → Result: Result Imaging indicated（Logic: High-risk factor → image. Otherwise, if a low-risk factor permits, test active rotation; full 45° each way clears the spine.）