Canadian C-Spine Rule
Does an alert, stable trauma patient need cervical spine imaging?
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About this tool
Three-step decision rule (high-risk factors, low-risk factors, active neck rotation) for cervical spine imaging.
Intended use
Alert (GCS 15) and stable adult trauma patients with possible cervical spine injury.
Outcome
Clinically important cervical spine injury
Time horizon
Index visit
Derivation population
Canadian emergency departments.
Do not use in
Age < 16, GCS < 15, unstable vitals, acute paralysis, known vertebral disease, previous C-spine surgery.
Limitations
- Requires an alert, cooperative patient.
- Not derived in children.
Clinical problems
Evidence
Evidence level
Strong evidence
Derived and externally validated in multiple cohorts (including prospective studies) and incorporated into major clinical guidelines. Methodology
Validation studies
100% sensitivity and 42.5% specificity for clinically important cervical spine injury.
References
- Original publicationStiell IG, Wells GA, Vandemheen KL, et al. The Canadian C-spine rule for radiography in alert and stable trauma patients. JAMA 2001;286:1841-1848. Find on PubMed (opens in a new tab)
- Validation studyStiell IG, Clement CM, McKnight RD, et al. The Canadian C-spine rule versus the NEXUS low-risk criteria in patients with trauma. N Engl J Med 2003;349:2510-2518. Find on PubMed (opens in a new tab)
Version history
| Version | Formula | Effective | Reviewer | Changes |
|---|---|---|---|---|
| v1.0.0 | Stiell 2001 | 2026-10-03 | — | Initial implementation with reference test vectors. |
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Clinical decision support only. Interpret results in the context of the individual patient and current guidance; HumanPulse does not replace professional medical judgment.