Interpretation
| Result | Meaning |
|---|---|
| Any high-risk factor | Image |
| No low-risk factor | Image |
| Low-risk factor + rotates 45° both ways | No imaging |
Formula
1) High risk (age ≥65, dangerous mechanism, paresthesias) → image. 2) Any low-risk factor (simple rear-end MVC, sitting in ED, ambulatory at any time, delayed neck pain, no midline tenderness)? If none → image. 3) Able to actively rotate 45° left and right → no imaging; unable → image.
Clinical pearls
- Inclusion: alert (GCS 15) and stable patients ≥16 y after blunt head/neck trauma with neck pain, or without neck pain but with visible injury above the clavicles, non-ambulatory status, or dangerous mechanism.
- Excluded from derivation: age <16, GCS <15, unstable vitals (SBP <90 or RR <10 or >24), penetrating trauma, acute paralysis, known vertebral disease, injury >48 h old, pregnancy, returning for reassessment.
- Dangerous mechanism: fall ≥3 ft or 5 stairs, axial load (e.g. diving), high-speed MVC (>100 km/h), rollover or ejection, motorized recreational vehicle, bicycle collision. Derivation sensitivity 100% for clinically important injury.
Examples
canadian c spine 40 yo rear-ended, ambulatory at scene, no midline tenderness, can rotate 45 both waysdoes a 70 year old after a low speed fall need neck imaging
FAQ
Canadian C-Spine Rule vs NEXUS: which is better?
In a head-to-head study (Stiell, NEJM 2003) the Canadian rule was more sensitive and specific than NEXUS in alert, stable adults.
Can I test rotation if there is midline tenderness?
Rotation is only assessed when at least one low-risk factor is present; absence of midline tenderness is itself one such factor.