Canadian C-spine Rule and the National Emergency X-Radiography Utilization Low-Risk Criteria for C-spine radiography in young trauma patients

J Pediatr Surg. 2009 May;44(5):987-91. doi: 10.1016/j.jpedsurg.2009.01.044.

Abstract

Purpose: The Canadian C-spine (cervical spine) Rule (CCR) and the National Emergency X-Radiography Utilization Low-Risk Criteria (NLC) are criteria designed to guide C-spine radiography in trauma patients. It is unclear how these 2 rules compare with young children.

Methods: This study retrospectively examined case-matched trauma patients 10 years or younger. Two cohorts were identified-cohort A where C-spine imaging was performed and cohort B where no imaging was conducted. The CCR and NLC criteria were then applied retrospectively to each cohort.

Results: Cohort A contained 125 cases and cohort B with 250 cases. Seven patients (3%) had significant C-spine injuries. In cohort A, NLC criteria could be applied in 108 (86.4%) of 125 and CCR in 109 (87.2%) of 125. National Emergency X-Radiography Utilization Low-Risk Criteria suggested that 70 (58.3%) cases required C-spine imaging compared to 93 (76.2%) by CCR. National Emergency X-Radiography Utilization Low-Risk Criteria missed 3 C-spine injuries, and CCR missed one. In cohort B, NLC criteria could be applied in 132 (88%) of 150 and CCR in 131 (87.3%) of 150. The NLC criteria identified 8 cases and CCR identified 13 cases that would need C-spine radiographs. Fisher's 2-sided Exact test demonstrated that CCR and NLC predictions were significantly different (P = .002) in both cohorts. The sensitivity of CCR was 86% and specificity was 94%, and the NLC had a sensitivity of 43% and a specificity of 96%.

Conclusions: Although CCR and NLC criteria may reduce the need for C-spine imaging in children 10 years and younger; they are not sensitive or specific enough to be used as currently designed.

Publication types

  • Comparative Study
  • Evaluation Study

MeSH terms

  • Age Factors
  • Canada
  • Case-Control Studies
  • Cervical Vertebrae / diagnostic imaging*
  • Cervical Vertebrae / injuries
  • Child
  • Child, Preschool
  • Cohort Studies
  • Decision Support Techniques*
  • Diagnostic Errors / prevention & control*
  • Emergencies
  • Humans
  • Infant
  • Neck Injuries / diagnostic imaging*
  • Radiography / standards
  • Radiography / statistics & numerical data
  • Retrospective Studies
  • Risk
  • Sensitivity and Specificity
  • Spinal Cord Injuries / diagnostic imaging
  • Spinal Fractures / diagnostic imaging
  • Unnecessary Procedures