The Canadian C-Spine Rule versus the NEXUS Low-Risk Criteria in Patients with Trauma. National Emergency X-Radiography Utilization Study Group. Hoffman JR, et al.Validity of a set of clinical criteria to rule out injury to the cervical spine in patients with blunt trauma.The Canadian C-spine rule for radiography in alert and stable trauma patients. If the patient is neither high or low risk, then the patient is moderate risk and requires imaging. The evaluation of the cervical spine (c-spine) with x-rays is a controversial area of trauma management (1, 2).C-spine assessment continues to be driven by the fear of the consequences associated with missed significant injury (1, 2, 3, 4).If there are no high-risk findings, check to see if the patient qualifies as a low-risk candidate where you might be able to clinically clear the c-spine without imaging. In adult blunt trauma patients with concern for C-spine injury, the Canadian C-spine Rule (CCR) is an effective clinical tool to screen for those that would.Determine if there are high-risk findings.Make sure that the patient meets the eligibility requirements as in the CCR study.No clinically apparent, painful distracting injury.No posterior midline neck pain or tenderness.StudyĪ patient's neck can be clinically cleared safely without radiographic imaging if all five low-risk conditions are met: Both studies primarily used plain films in evaluating their patients. This study concludes that the Canadian C-spine rule appears to have better diagnostic accuracy than the NEXUS criteria.The National Emergency X-radiography Utilization Study (NEXUS) and Canadian C-spine Rules (CCR) are both validated studies which both quote a high sensitivity (over 99%) in detecting clinically significant cervical spine fractures. For both rules, a negative test was more informative for reducing the probability of a clinically important cervical spine injury. The Canadian C-Spine Rules (CCR) and the National Emergency X-Radiography Utilization Group (NEXUS) criteria allow clinicians to 'clear' low-risk patients of c-spine injury, obviating the need for. One study directly compared the accuracy of these 2 rules using the same cohort and found that the Canadian C-spine rule had better accuracy. Algorithm: Summary Statement: The Canadian C-Spine Rule (CCR) evolved from a landmark study. I recently attended the multidisciplinary symposium on the cervical spine, held in conjunction with the Musculoskeletal Physiotherapy 13th biennial conference. If pro-spectively validated in other cohorts, this rule has the potential to significantly reduce practice variation and inefficiency in ED use of C-spine radiography. For NEXUS, sensitivity ranged from 0.83 to 1.00 and specificity ranged from 0.02 to 0.46. This is a clinical decision rule that is highly sensitive for detecting acute C-spine injury and can help emergency department physicians with decisions regarding need for imaging in alert and stable patients. Conclusion We have derived the Canadian C-Spine Rule, a highly sensitive deci-sion rule for use of C-spine radiography in alert and stable trauma patients. For the Canadian C-spine rule, sensitivity ranged from 0.90 to 1.00 and specificity ranged from 0.01 to 0.77. The Canadian cervical spine rule (CCR) and The National Emergence X-Radiography utilization study (NEXUS) are the most commonly used clinical decision rules after blunt cervical trauma. Methodologic quality was assessed using the Quality Assessment of Diagnostic Accuracy Studies criteria. Clinical decision rules can help clinicians to rule out serious injuries without imaging. The study included articles that reported on a cohort of patients who experienced blunt trauma and for whom clinically important cervical spine injury detectable by diagnostic imaging was the differential diagnosis evaluated the diagnostic accuracy of the Canadian C-spine rule or NEXUS or both and used an adequate reference standard. A recent systematic review has investigated the diagnostic accuracy of the Canadian C-spine rule and the National Emergency X-Radiography Utilization Study (NEXUS) criteria to assist emergency physicians to assess the need for cervical spine imaging. There is uncertainty about the optimal approach to screen for clinically important cervical spine (C-spine) injury following blunt trauma.