🦴 Canadian C-Spine Rule
Decide on cervical-spine imaging after trauma with the Canadian C-Spine Rule.
Clinical takeaway
Applies to alert (GCS 15), stable trauma patients.
Loading calculator…
Paste the link in Slack, Teams, X, or LinkedIn — the preview image comes from this page’s Open Graph card.
When to use
Reduce unnecessary C-spine imaging in alert, stable patients.
How it works
Image if any high-risk factor is present; otherwise, if a low-risk factor permits safe assessment of rotation, clear if the patient can rotate the neck 45° each way.
Key points
- Applies to alert (GCS 15), stable trauma patients.
- Very high sensitivity for significant injury.
- More specific than NEXUS, reducing imaging.
References
Decision support for licensed clinicians only; not a substitute for clinical judgement, diagnosis or local protocols.
Worked calculation
The values below come from this tool's own example placeholders and are computed server-side with the formula shown on this page, so the arithmetic can be checked quickly. It demonstrates how to substitute values only — it is not clinical advice and not a real case.
| Any high-risk factor (age ≥ 65, dangerous mechanism, or paraesthesias in extremities) | No |
|---|---|
| Any low-risk factor allowing safe assessment (simple rear-end MVC, sitting in ED, ambulatory, delayed neck pain, or no midline tenderness) | Yes |
| Able to actively rotate neck 45° left and right | Yes |
→ResultNo imaging needed — clinically clear
- Logic：High-risk factor → image. Otherwise, if a low-risk factor permits, test active rotation; full 45° each way clears the spine.
| Any high-risk factor (age ≥ 65, dangerous mechanism, or paraesthesias in extremities) | Yes |
|---|---|
| Any low-risk factor allowing safe assessment (simple rear-end MVC, sitting in ED, ambulatory, delayed neck pain, or no midline tenderness) | No |
| Able to actively rotate neck 45° left and right | No / not tested |
→ResultImaging indicated
- Logic：High-risk factor → image. Otherwise, if a low-risk factor permits, test active rotation; full 45° each way clears the spine.
Frequently asked questions
- What is Canadian C-Spine Rule?
- Decide on cervical-spine imaging after trauma with the Canadian C-Spine Rule.
- How is Canadian C-Spine Rule calculated? What is the core formula?
- Image if any high-risk factor is present; otherwise, if a low-risk factor permits safe assessment of rotation, clear if the patient can rotate the neck 45° each way.
- When is Canadian C-Spine Rule used?
- Reduce unnecessary C-spine imaging in alert, stable patients.
- What are the key clinical points for Canadian C-Spine Rule?
- Applies to alert (GCS 15), stable trauma patients. Very high sensitivity for significant injury. More specific than NEXUS, reducing imaging.
- What are the limits and cautions when using Canadian C-Spine Rule?
- For licensed clinicians and clinical researchers. Interpret results with history, investigations and local protocols; not a diagnosis or prescription, and not a substitute for multidisciplinary decision-making or local guidelines.
- How is Canadian C-Spine Rule calculated in practice? Can you show a worked example?
- Inputs: Any high-risk factor (age ≥ 65, dangerous mechanism, or paraesthesias in extremities) No, Any low-risk factor allowing safe assessment (simple rear-end MVC, sitting in ED, ambulatory, delayed neck pain, or no midline tenderness) Yes, Able to actively rotate neck 45° left and right Yes → Result: Result No imaging needed — clinically clear（Logic: High-risk factor → image. Otherwise, if a low-risk factor permits, test active rotation; full 45° each way clears the spine.） Inputs: Any high-risk factor (age ≥ 65, dangerous mechanism, or paraesthesias in extremities) Yes, Any low-risk factor allowing safe assessment (simple rear-end MVC, sitting in ED, ambulatory, delayed neck pain, or no midline tenderness) No, Able to actively rotate neck 45° left and right No / not tested → Result: Result Imaging indicated（Logic: High-risk factor → image. Otherwise, if a low-risk factor permits, test active rotation; full 45° each way clears the spine.）