Tuesday, April 23, 2019

Canadian C-Spine Rule

Taming The SRU
Taming The SRU - April 22, 2019 - By Gawron D

..."Since the creation of both the NEXUS and Canadian clinical decision rules, only one study has directly compared the accuracy of the rules against one another. This study was published in 2003 by the same authors of the Canadian C-Spine Rule.  They applied the same methods as their validation study in 2001 to a population of 8,283 blunt trauma patients, and ultimately had 169 patients (2%) with clinically important cervical spine injuries. 
So in this study, the Canadian C-Spine Rule performed better than NEXUS. One interesting finding, however, was for 845 (10.2%) of the patients, physicians did not evaluate range of motion as required by the CCR algorithm. This may suggest that there is some physician discomfort and decreased compliance when it comes to applying the CCR rule, perhaps due to concern that range of motion testing may exacerbate an injury. An additional 2012 systematic review was published in the Canadian Medical Association Journal to investigate the diagnostic accuracy of the two rules. However, all of the studies included in the review besides the one discussed above were validation studies and did not directly compare the two rules against each other. The review found a combined sensitivity of NEXUS to be 83-100% and Canadian to be 90-100% and the authors concluded that the Canadian C-Spine rule appears to have a better diagnostic accuracy."