Canadian C-Spine Rule
Apply the validated Canadian C-Spine Rule to decide whether cervical spine X-ray or CT is needed after blunt trauma.
Use the Canadian C-Spine Rule
Patient Criteria
For alert (GCS 15), stable adults after blunt trauma only.
Complete the criteria and click Evaluate to see the recommendation.
Imaging Required
Do not clear cervical spine without imaging
Clinical Guidance
Obtain cervical spine X-ray (AP, lateral, odontoid) or CT as indicated by mechanism and clinical assessment. Maintain immobilization pending imaging results.
Imaging Not Required
Low-risk pathway — cervical spine can be clinically cleared
No high-risk factors identified, at least one low-risk factor is present, and the patient can actively rotate the neck 45° in both directions. Per the Canadian C-Spine Rule, radiography is not required.
Clinical Guidance
Clinical clearance is appropriate per CCR. Document the findings and the basis for the decision. Apply clinical judgment and local protocols before removing immobilization.
Decision Pathway
Disclaimer: This tool is for educational and clinical decision-support purposes only. It does not replace physician judgment, full clinical assessment, or institutional protocols. Always verify with current literature and local guidelines.
Summary
The Canadian C-Spine Rule (CCR) is a validated 3-step clinical decision algorithm for determining whether cervical spine imaging is necessary after blunt trauma in alert, stable adults. It evaluates high-risk factors that mandate imaging, low-risk factors that permit range-of-motion assessment, and the patient's ability to actively rotate the neck. The original 2001 JAMA study demonstrated 100% sensitivity and 42.5% specificity, and the 2003 NEJM validation confirmed its superior specificity over NEXUS.
How it works
- Step 1 checks for high-risk factors that mandate imaging (age ≥65, dangerous mechanism, or paresthesias in extremities).
- Step 2 checks for low-risk factors that allow a range-of-motion assessment.
- Step 3 checks whether the patient can actively rotate the neck 45° left and right.
- If no high-risk factor AND a low-risk factor is present AND rotation is possible, imaging is not required.
- Any high-risk factor or inability to assess rotation triggers the imaging-required pathway.
Use cases
- ED triage of alert, stable adults after motor vehicle collision.
- Clinical decision support for fall-related neck pain evaluation.
- Reducing unnecessary cervical spine X-rays in low-risk patients.
- Teaching clinical decision rules to medical students and residents.
- Documenting rational for imaging or clearance in the medical record.