assessment for cervical spinal injury - Canadian C - spine rule

Last reviewed 01/2018

Assessment for cervical spine injury

Assess whether the person is at high, low or no risk for cervical spine injury using the Canadian C-spine rule as follows:

• the person is at high risk if they have at least one of the following high-risk factors:
  • age 65 years or older
  • dangerous mechanism of injury (fall from a height of greater than 1 metre or 5 steps, axial load to the head - for example diving, high-speed motor vehicle collision, rollover motor accident, ejection from a motor vehicle, accident involving motorised recreational vehicles, bicycle collision, horse riding accidents)
  • paraesthesia in the upper or lower limbs
    
    
• the person is at low risk if they have at least one of the following low-risk factors:
  • involved in a minor rear-end motor vehicle collision
  • comfortable in a sitting position
  • ambulatory at any time since the injury
  • no midline cervical spine tenderness
  • delayed onset of neck pain
    
    
• the person remains at low risk if they are:
  • unable to actively rotate their neck 45 degrees to the left and right (the range of the neck can only be assessed safely if the person is at low risk and there are no high-risk factors)
    
    
• the person has no risk if they:
  • have one of the above low-risk factors and are able to actively rotate their neck 45 degrees to the left and right

Note that applying the Canadian C-spine rule to children is difficult and the child's developmental stage should be taken into account

Reference:

• NICE (February 2016).Spinal injury