A clinical decision rule to determine the need for diagnostic imaging for alert and stable trauma patients gcs 15 with neck pain. The rules have been demonstrated to decrease unnecessary diagnostic imaging and emergency room wait times which enhances patient comfort and reduces health care costs. The canadian cspine rule for alert glasgow coma scale score 15 and stable trauma patients for whom cervical spine injury is a concern, including patients with either posterior neck pain with any blunt mechanism of injury or no neck pain but some visible injury above the clavicles. What are exclusion criteria from the canadian cspine rule. The canadian cspine rule versus the nexus lowrisk criteria in patients with trauma. Two decision rules, the national emergency x radiography utilization study nexus low risk criteria nlc and the canadian cspine rule ccr, both published in 2001, were developed to reduce the unnecessary use of cspine radiography. Most relevant lists of abbreviations for ccr canadian cspine rule. Ian stiell wrote a paper 1 about the uptake and reallife implementation of his four clinical decision rules or as we prefer to call them, clinical decision tools.
Depending on practice environment, it may not be considered acceptable to miss any intracranial injuries, regardless of whether they would have required intervention. Canadian cspine rule ottawa hospital research institute. Pdf canadian cspine rule study for alert and stable. Ankle and foot injuries are common presentations to the emergency department, and it can often be difficult to know whether imaging is required. The outofhospital validation of the canadian cspine rule by. Overview and comparison of nexus and canadian cspine rules difficult to determine exactly what type of injuries could interfere with a thorough physical exam or distract a patient from other injuries. Conclusion we have derived the canadian cspine rule, a highly sensitive decision rule for use of cspine radiography in alert and stable trauma patients. The canadian cspine rule ccr is a decision making tool used to determine when. The ottawa ankle and foot rules are highly sensitive and widely used as a tool to reduce unnecessary imaging in emergency departments.
Ian stiell and his colleagues developed the ottawa ankle rules 12 to facilitate this decision. For those imaged, standard diagnostic imaging may have included plain radiography, oblique views. A multicenter program to implement the canadian cspine rule by emergency department triage nurses. The canadian cspine rule for radiography in alert and.
C spine rule laminate v7 copy ubc physical therapy programs. The cervical spine rule will permit physicians to standardize care of alert, stable trauma patients, to rapidly clear the cervical spine, and to be much more selective in the use of cervical spine radiography without jeopardizing patient care. Should only be used in patients who are alert and oriented, presenting within 14 days of headache, without history of head trauma or fall in the past 7 days. Applying the canadian cspine rule would allow healthcare providers to safely decrease the need for imaging.
Validation of the ottawa ankle rules in children with ankle injuries. One study directly compared the accuracy of these 2 rules using the same cohort and found that the canadian cspine rule had better accuracy. Implementation of the canadian cspine rule full text. Listing a study does not mean it has been evaluated by the u. The combined ottawa ankle and foot rules have a sensitivity of 97. The outofhospital validation of the canadian cspine. Pmc free article plint ac, bulloch b, osmond mh, stiell i, dunlap h, reed m, tenenbein m, klassen tp.
Implementation of the canadian cspine rule the safety and scientific validity of this study is the responsibility of the study sponsor and investigators. The canadian cspine rule was developed from high quality research and found to be highly sensitive 98100%, reliable, clinically applicable, simple to use, and superior to. Advise patients to seek followup care if their pain or ability to bear weight has not improved in five to seven days. Implementation of the ottawa ankle rules by nurses working in an accident and emergency department. The canadian cspine rule clinically clears cervical spine fracture without imaging. The canadian cspine rule for radiography in alert and stable trauma. The canadian cspine rule ccr was developed to help physicians determine which trauma patients need cspine imaging.
We designed the canadian cspine rule for the clinical clearance. Overtesting for cervical spine injury is a widely acknowledged problem. Define whether any high risk factors are present such as age. Staff radiologists interpreting the radiographs were provided with routine clinical information but not the contents of the data form. Canadian cspine rules are a set of guidelines that help a clinician decide if cervical spine imaging is not appropriate for a trauma patient in the emergency department.
The canadian ct head rule is a wellvalidated clinical decision aid that allows physicians to safely rule out the presence of intracranial injuries that. Still always be careful not to induce unneeded fear into the patient but still absolutely worth knowing well. Canadian cspine rule cervical spine fractures youtube. Part i details the background and rationale for the development of the canadian cspine rule. The ottawa rules are a set of clinical decision rules developed by dr. Serious clinically important injuries posttrauma are uncommon 150 000 adult patients. Pdf validation of the canadian cspine rule in the uk emergency.
Pdf this paper is part 1 of a 2part series to describe the background and methodology for the canadian cspine rule study to develop a. Senior scientist, ottawa hospital research institute canadian cspine rule for alert glasgow coma scale 15 and stable trauma patients where cervical spine injury is a concern 1. Criteria ottawa knee rules xray for acute injury of the knee. The canadian cspine rule was developed from high quality research and found to be highly sensitive 98100%, reliable, clinically applicable, simple to use, and superior to both clinical judgement and similar decision rules.
Clinical decision rules risk stratification scales acls. A pragmatic evaluation of the canadian cspine rule by paramedics the safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Ian stiell and his research team at the ottawa hospital research institute and the university of ottawa. If this is the first time you use this feature, you will be asked to authorise cambridge core to connect with your account.
Orthopedic manual therapy for the pediatric patient. The canadian cspine rule article pdf available in new england journal of medicine 35014. Usethe ottawa knee rules okr to exclude fractures and reduce unnecessary imaging. Pdf to determine the potential of the canadian cervical spine rule ccr to safely reduce the number of cervical spine.
The canadian cspine rule for radiography in alert and stable ncbi. If this is the case, an xray of the cervical spine. The canadian ct head rules have been validated in multiple settings and have consistently demonstrated that they are 100% sensitive for detecting injuries that will require neurosurgery. Boarded and collared for reason other than cspine 2. If prospectively validated in other cohorts, this rule has the potential to significantly reduce practice variation and inefficiency in. Unable to assess the effectiveness of or these cpr s.
Senior scientist, ottawa hospital research institute. Ottawasclerkship guidetoemergency medicine omar anjum laura olejnik shahbaz syed first edition 2017. The canadian ct head and cspine ccc study is a large collaborative effort to develop clinical decision rules for the use of ct head in minor head injury and for the use of cervical spine radiography in alert and stable trauma victims. Only apply to patients with glasgow coma scale gcs 15 and at least one of the following. Canadian cspine rule the ottawa hospital research institute. The goal of the canadian cspine rule is to rule out cervical spine fractures after blunt trauma to the head. Cspine rule versus the nexus lowrisk criteria in patients with trauma. The potential radiography ordering rate would be 58. Banek, university of ottawa, ottawa, ontario, canada. Ccr is highly sensitive for csi, with the majority of studies finding it catches 99100% of these types of injuries. Canadian cspine rule and the national emergency xradiography utilization lowrisk criteria for cspine radiography in young trauma patients. Developed by the bc physical therapy cervical spine rule advisory group. Accuracy of the canadian cspine rule and nexus to screen. The canadian cspine rule for radiography in alert and stable trauma patients.
This paper is part i of a 2part series to describe the background and methodology for the canadian cspine rule study to develop a clinical decision rule for rational imaging in alert and stable trauma patients. Any highrisk factor which mandates diagnostic imaging age. Over the 24 month trial period, 148 doctors were provided. The ottawa sah rule was developed for use in an emergency department setting in patients presenting with acute headache. Ian stiell, professor in the department of emergency medicine at the university of ottawa, discussing the assessment of an ankle andor foot injury using the ottawa ankle. Ottawa neck rules pdf for alert gcs15 and stable trauma patients where cervical spine injury is a concern. Current use of radiography is inefficient and variable, in part because there has been a lack of evidencebased guidelines to assist emergency physicians. We have derived the canadian cspine rule, a highly sensitive decision rule for use of cspine radiography in alert and stable trauma patients.
The canadian cspine rule is applicable to patients who are in an alert glasgow coma scale score of 15 and stable condition following trauma where cervical spine injury is a concern. The canadian cspine cervicalspine rule ccr and the national emergency xradi ography utilization study nexus lowrisk criteria nlc are decision rules to guide the use of cervicalspine. The paper concludes that future research should identify implementation barriers and explore strategies to achieve better knowledge uptake in the ed. For the canadian cspine rule, sensitivity ranged from 0. Canadian cspine rule department of physical therapy. Canadian cspine rule study for alert and stable trauma. The canadian cspine rule ccr is a decision making tool used to determine when radiography should be utilized in patients following trauma. The canadian cspine rule a clinical decision rule to determine the need for diagnostic imaging for alert and stable trauma patients gcs 15 with neck pain developed by dr. Recently validated at nine canadian sites and now the subject of a large cihrfunded.
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