The Likelihood Of A Cervical Spine Injury

Canadian C Spine rule to determine cervical spine injury imaging needs outperforms NEXUS

/ Author:  / Reviewed by: Robert Carlson, M.D

(RxWiki News) Neck injuries are treated with great caution to avoid further complications including paralysis. This extra level of care often leads to the overuse of expensive radiography.

A recent study compared the use of two different tools commonly used to decide whether imaging of the cervical spine is needed after a blunt trauma injury.

The study found that when comparing the Canadian C-spine rule and the National Emergency X-Radiography Utilization Study (NEXUS) criteria, the Canadian C-Spine rule has better diagnostic accuracy.

"See a doctor after any traumatic accident."

Chris G. Maher, PhD, director of the Musculoskeletal Division of The George Institute for Global Health and colleagues reviewed existing studies that investigated the use of the Canadian C-spine rule or NEXUS criteria for patients who needed imaging of the spine after head trauma.

Of 578 articles found, 15 were used in this study. Nine studies evaluated the Canadian C-spine rule and 7 assessed the NEXUS rule. One of the studies was considered to be a direct comparison of the two rules. The Canadian C-spine Rule takes into account age, nature of accident, extremity numbness, tenderness or pain, the ability to move and range of motion to determine if radiography is necessary.

The Nexus Rule recommends radiography for patient with signs of intoxication, altered mental status, neurologic deficit, spinal tenderness or a distracting injury.

Both rules showed a good ability to exclude the possibility of cervical spine injuries without sacrificing the patient’s health. However, the Canadian C-spine rule had a better accuracy and a lower rate of false negatives.

A negative result indicates that a patient does not need to undergo diagnostic imaging in both tests. A false negative means that someone who should be screened further is not and a false positive means unnecessary screening is being carried out.

The Canadian C-Spine Rule had a rate of 0 percent to 0.11 percent false negative results, compared to 0 to 1.0 percent for the NEXUS criteria. The Canadian C-Spine and NEXUS criteria reduce rates of imaging by 42.0 and 30.9 percent, respectively, without missing a clinically important cervical spine injury.

While it is important that all patients who need care receive it, it is also important that excessive imaging is prevented to save time, effort and healthcare costs.

The authors believe that there is currently an overuse of imaging which may be due to a clinician’s fear of litigation or uncertainty of a tool’s accuracy. There is no indication that the patient receives a psychological or physical benefit from imaging when there is no suggestion that it is needed.

Less overuse of imaging will occur as patients and doctors become more educated on tools like NEXUS and Canadian C-Spine and their capabilities.

This study was published in the Canadian Medical Association Journal. Authors report associations with several educational entities.

Reviewed by: 
Review Date: 
November 12, 2012
Last Updated:
March 28, 2013