Canadian C-spine rule more accurate in diagnosing important cervical spine injuries than other rules

To screen for cervical spine injuries such as fractures in the emergency department, the Canadian C-spine rule appears to be more accurate compared with NEXUS, another commonly used rule, according to a study in CMAJ (Canadian Medical Association Journal). NEXUS stands for the National Emergency X-Radiography Utilization Study.

"In the only direct comparison, the Canadian C-spine rule appeared to have better diagnostic accuracy, and it should be used over NEXUS to assess the need for imaging," writes Dr. Chris Maher, Director, Musculoskeletal Division, The George Institute for Global Health, The University of Sydney, Sydney, Australia, with coauthors.

Both rules, which were developed independently using large patient samples, are recommended in many international guidelines to help exclude important cervical spine injuries. However, there is no consensus as to which rule is preferable. Screening tools such as these are useful because they can reduce the need for unnecessary diagnostic imaging, which can expose patients to radiation, and is also costly.

Researchers from Australia and The Netherlands looked at 15 research studies evaluating the use of either or both rule in diagnosing cervical spine injuries. However, only one study directly compared the two rules; all 14 other studies included in the analysis assessed accuracy of each rule separately. The Canadian C-spine rule appeared to have better and a lower rate of false negatives compared with NEXUS. A negative test helps exclude an important spinal injury and thus the need for .

However, both rules are effective in excluding cervical spine injuries while ensuring patient safety as this and previous studies show.

"Despite these findings, there is a more liberal use of imaging in current clinical practice, which may reflect patient preference, physicians' fear of litigation or missing a fracture, or uncertainty of the application or accuracy of the screening tools," write the authors. "Improved education of physicians may facilitate greater use of these rules."

It is also important to educate patients that these screening tools are effective and that imaging is not necessary if there are no signs of cervical injury. Follow-up strategies for patients discharged without imaging could be used to ease patient anxiety.

More information: www.cmaj.ca/lookup/doi/10.1503/cmaj.120675

add to favorites email to friend print save as pdf

Related Stories

Recommended for you

Recorded Ebola deaths top 7,000

10 hours ago

The worst Ebola outbreak on record has now killed more than 7,000 people, with many of the latest deaths reported in Sierra Leone, the World Health Organization said as United Nations Secretary-General Ban ...

Liberia holds Senate vote amid Ebola fears (Update)

14 hours ago

Health workers manned polling stations across Liberia on Saturday as voters cast their ballots in a twice-delayed Senate election that has been criticized for its potential to spread the deadly Ebola disease.

Evidence-based recs issued for systemic care in psoriasis

Dec 19, 2014

(HealthDay)—For appropriately selected patients with psoriasis, combining biologics with other systemic treatments, including phototherapy, oral medications, or other biologic, may result in greater efficacy ...

Bacteria in caramel apples kills at least four in US

Dec 19, 2014

A listeria outbreak believed to originate from commercially packaged caramel apples has killed at least four people in the United States and sickened 28 people since November, officials said Friday.

Steroid-based treatment may answer needs of pediatric EoE patients

Dec 19, 2014

A new formulation of oral budesonide suspension, a steroid-based treatment, is safe and effective in treating pediatric patients with eosinophilic esophagitis (EoE), according to a new study in Clinical Gastroenterology and Hepatology, the official clinical practice journal ...

User comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.