Canadian C-Spine Rule

Canadian emergency departments (EDs) annually treat 1.3 million patients who have suffered blunt trauma from falls or motor vehicle collisions and who are at risk for cervical spine (c-spine) injury. Most such cases are alert and stable adults and less than 1% has a c-spine fracture. A majority of trauma victims transported in ambulances are protected by a backboard, collar, and sandbags and, on arrival at the ED, are sent to high acuity resuscitation rooms, where they remain fully immobilized for hours until physician assessment and x-rays are complete. ^[i]

This prolonged immobilization is often unnecessary and adds considerably to patient discomfort and to the burden on our overcrowded Canadian EDs in an era when they are under unprecedented pressures. These patients use valuable ED resuscitation room space and endure long wait times, which contribute to lower patient satisfaction.

Researchers at the Ottawa Hospital have developed a clinical decision rule, the Canadian C-Spine Rule (CCR), to allow clinicians to “clear” the cervical spine without the need for an x-ray and to decrease immobilization times. This rule has been widely adopted by Emergency Department (ED) physicians and has recently completed testing for accuracy, reliability and safety amongst ED triage nurses.

This project will optimize resources through the use of interprofessional teams, allowing for specially trained nurses to assess patients using the Canadian C-Spine Rule, and potentially decrease ER wait times and increase patient satisfaction by quickly and effectively identifying patients who do not require immobilization.

Currently, the following hospitals are participating in the CAHO Canadian C-Spine Rule ARTIC Project: Kingston General Hospital, London Health Sciences Centre, Hôpital Montfort, North York General Hospital, St Michael’s Hospital, Sudbury Regional Hospital, Sunnybrook Health Sciences Centre, Thunder Bay Regional Health Sciences Centre, and University Health Network.

[i] Ian G. Stiell MD MSc, Catherine M. Clement RN, Annette O’Connor RN PhD, Barbara Davies RN PhD, Christine Leclair BScN, Pamela Sheehan RN, Tamara Clavet RN, Christine Beland RN MScN, Taryn MacKenzie BScN, George A. Wells PhD. Multicentre prospective validation of use of the Canadian C-Spine Rile by triage nurses in the emergency department. CMAJ, August 10, 2010. 182 (11), p. 12