The Canadian C-Spine Rule for Radiography in Alert and Stable Trauma Patients

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Abstract
More than 1 million patients with blunt trauma and potential cervical spine (C-spine) injury are treated each year in US emergency departments (EDs).1,2 Among those patients presenting with intact neurological status (arriving either walking or by ambulance), the incidence of acute fracture or spinal injury is less than 1%.3-5 Due to concerns about potentially disabling spinal injuries, most clinicians make liberal use of C-spine radiography.6-9 Nevertheless, such practice is inefficient—more than 98% of C-spine radiographs are negative for fracture.10-16 Furthermore, there is considerable practice variation among well-trained emergency physicians, with radiography rates ranging as much as 6-fold.17 Cervical spine radiography is an example of a "little ticket" item, a low-cost procedure that significantly adds to health care costs due to its high volumes of use.18,19