Diferencia entre revisiones de «Canadian cervical spine rule»

Revisión del 12:38 3 sep 2015

Background

Only applies to GCS=15 and stable blunt neck trauma. Not applicable for non-trauma, GCS<15, Hemodynamically unstable, Age <16, Acute paralysis, previous spinal disease or surgery.

Rule

If ANY High Risk factor present – then get an X-ray

Age >65 years
Dangerous mechanism
- fall from elevation ≥ 3 feet / 5 stairs
- axial load to head, e.g. diving
- MVC high speed (>100km/hr), rollover, ejection
- motorized recreational vehicles
- bicycle struck or collision
Parasthesia in extremities

If ANY Low-Risk factor present – then assess clinically with ROM testing

(If the answer to any of these is NO then get an x-ray)

Simple rear-end MVC which DOES NOT include the following
- pushed into oncoming traffic
- hit by bus / large truck
- rollover
- hit by high speed vehicle
Sitting in ED
Ambulatory at anytime
Delayed onset of neck pain
Absence midline c-spine tenderness

Able to actively rotate neck?

45 Degree Left and Right? If able then NO x-ray needed. If unable, get an x-ray.

Canadian rule vs. Nexus

Sensitivity

Canadian 99.4% vs Nexus 90.7%

Specificity

Canadian 45.1% vs. Nexus 36.8%

Based on a prospective cohort trial Canadian rule "would have missed 1 patient and the [Nexus rule] would have missed 16 patients with important injuries."

References

N Engl J Med 2003; 349:2510-2518
http://www.ohri.ca/emerg/cdr/cspine.html

Authors:

@@ Línea 4: / Línea 4: @@
 ==Rule==
 === If ANY High Risk factor present – then get an X-ray  ===
-#Age &gt;65 years
+*Age &gt;65 years
-#Dangerous mechanism
+*Dangerous mechanism
-##fall from elevation ≥ 3 feet / 5 stairs
+**fall from elevation ≥ 3 feet / 5 stairs
-##axial load to head, e.g. diving
+**axial load to head, e.g. diving
-##MVC high speed (&gt;100km/hr), rollover, ejection
+**MVC high speed (&gt;100km/hr), rollover, ejection
-##motorized recreational vehicles
+**motorized recreational vehicles
-##bicycle struck or collision
+**bicycle struck or collision
-#Parasthesia in extremities
+*Parasthesia in extremities
 === If ANY Low-Risk factor present – then assess clinically with ROM testing  ===
 (If the answer to any of these is NO then get an x-ray)
-#Simple rear-end MVC which DOES NOT include the following
+*Simple rear-end MVC which DOES NOT include the following
-##pushed into oncoming traffic
+**pushed into oncoming traffic
-##hit by bus / large truck
+**hit by bus / large truck
-##rollover
+**rollover
-##hit by high speed vehicle
+**hit by high speed vehicle
-#Sitting in ED
+*Sitting in ED
-#Ambulatory at anytime
+*Ambulatory at anytime
-#Delayed onset of neck pain
+*Delayed onset of neck pain
-#Absence midline c-spine tenderness
+*Absence midline c-spine tenderness
 === Able to actively rotate neck?  ===
-#45 Degree Left and Right? If able then NO x-ray needed. If unable, get an x-ray.
+*45 Degree Left and Right? If able then NO x-ray needed. If unable, get an x-ray.
 == Canadian rule vs. Nexus  ==