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The Canadian C-spine rule for radiography in alert and stable trauma patients.
- Source :
-
JAMA [JAMA] 2001 Oct 17; Vol. 286 (15), pp. 1841-8. - Publication Year :
- 2001
-
Abstract
- Context: High levels of variation and inefficiency exist in current clinical practice regarding use of cervical spine (C-spine) radiography in alert and stable trauma patients.<br />Objective: To derive a clinical decision rule that is highly sensitive for detecting acute C-spine injury and will allow emergency department (ED) physicians to be more selective in use of radiography in alert and stable trauma patients.<br />Design: Prospective cohort study conducted from October 1996 to April 1999, in which physicians evaluated patients for 20 standardized clinical findings prior to radiography. In some cases, a second physician performed independent interobserver assessments.<br />Setting: Ten EDs in large Canadian community and university hospitals.<br />Patients: Convenience sample of 8924 adults (mean age, 37 years) who presented to the ED with blunt trauma to the head/neck, stable vital signs, and a Glasgow Coma Scale score of 15.<br />Main Outcome Measure: Clinically important C-spine injury, evaluated by plain radiography, computed tomography, and a structured follow-up telephone interview. The clinical decision rule was derived using the kappa coefficient, logistic regression analysis, and chi(2) recursive partitioning techniques.<br />Results: Among the study sample, 151 (1.7%) had important C-spine injury. The resultant model and final Canadian C-Spine Rule comprises 3 main questions: (1) is there any high-risk factor present that mandates radiography (ie, age >/=65 years, dangerous mechanism, or paresthesias in extremities)? (2) is there any low-risk factor present that allows safe assessment of range of motion (ie, simple rear-end motor vehicle collision, sitting position in ED, ambulatory at any time since injury, delayed onset of neck pain, or absence of midline C-spine tenderness)? and (3) is the patient able to actively rotate neck 45 degrees to the left and right? By cross-validation, this rule had 100% sensitivity (95% confidence interval [CI], 98%-100%) and 42.5% specificity (95% CI, 40%-44%) for identifying 151 clinically important C-spine injuries. The potential radiography ordering rate would be 58.2%.<br />Conclusion: We have derived the Canadian C-Spine Rule, a highly sensitive decision rule for use of C-spine radiography in alert and stable trauma patients. If prospectively validated in other cohorts, this rule has the potential to significantly reduce practice variation and inefficiency in ED use of C-spine radiography.
- Subjects :
- Adult
Aged
Canada
Cervical Vertebrae diagnostic imaging
Female
Humans
Male
Middle Aged
Outcome and Process Assessment, Health Care
Prospective Studies
Radiography standards
Regression Analysis
Risk Assessment
Sensitivity and Specificity
Tomography, X-Ray Computed
Craniocerebral Trauma diagnostic imaging
Decision Support Techniques
Emergency Medical Services standards
Neck Injuries diagnostic imaging
Traumatology standards
Wounds, Nonpenetrating diagnostic imaging
Subjects
Details
- Language :
- English
- ISSN :
- 0098-7484
- Volume :
- 286
- Issue :
- 15
- Database :
- MEDLINE
- Journal :
- JAMA
- Publication Type :
- Academic Journal
- Accession number :
- 11597285
- Full Text :
- https://doi.org/10.1001/jama.286.15.1841