Canadian Cervical Spine rule compared with computed tomography: a prospective analysis

J Trauma. 2011 Aug;71(2):352-5; discussion 355-7. doi: 10.1097/TA.0b013e318220a98c.


Background: The Canadian cervical spine rule (CCS) has been found to be an effective tool to determine the need for radiographic evaluation of the cervical spine (c-spine) incorporating both clinical findings and mechanism. Previously, it has been validated only through clinical follow-up or selective use of X-rays. The purpose of this study was to validate it using computed tomography (CT) as the gold standard to identify fractures.

Methods: Prospective evaluation was performed on 3,201 blunt trauma patients who were screened by CCS and were compared with a complete c-spine CT. CSS positive indicated at least one positive clinical or mechanism finding, whereas CT positive indicated presence of a fracture.

Results: There were 192 patients with c-spine fractures versus 3,009 without fracture on CT. The fracture group was older (42.7 ± 19.0 years vs. 37.8 ± 17.5 years, p = 0.0006), had a lower Glasgow Coma Scale score (13.8 ± 4.2 vs. 14.4 ± 4.3, p < 0.0001), and lower systolic blood pressure (133.3 ± 23.8 mm Hg vs. 139.5 ± 23.1 mm Hg, p = 0.0023). The sensitivity of CCS was 100% (192/192), specificity was 0.60% (18/3009), positive predictive value was 6.03% (192/3183), and negative predictive value was 100% (18/18). Logistic regression identified only 8 of the 19 factors included in the CCS to be independent predictors of c-spine fracture.

Conclusions: CCS is very sensitive but not very specific to determine the need for radiographic evaluation after blunt trauma. Based on this study, the rule should be streamlined to improve specificity while maintaining sensitivity.

Publication types

  • Comparative Study

MeSH terms

  • Adult
  • Algorithms
  • Canada
  • Cervical Vertebrae / diagnostic imaging*
  • Cervical Vertebrae / injuries*
  • Decision Support Techniques*
  • Emergency Medical Services / standards
  • Female
  • Humans
  • Male
  • Middle Aged
  • Prospective Studies
  • Risk Factors
  • Sensitivity and Specificity
  • Spinal Fractures / diagnosis*
  • Spinal Fractures / diagnostic imaging
  • Tomography, X-Ray Computed
  • Traumatology / standards*
  • Wounds, Nonpenetrating / diagnostic imaging*
  • Wounds, Nonpenetrating / epidemiology
  • Young Adult