After blunt trauma to the head, it is essential to screen for fractures, dislocation, or ligamentous instability in the cervical spine, which would require specialist follow-up with possible surgical intervention as these injuries can have fatal consequences ranging from spinal cord injury to death if they are not detected.
The Canadian C-Spine rules are a clinical decision rule that’s used to safely rule out cervical spine fractures in alert, stable patients without the need for radiographic imagery.
A review by Michaleff et al. (2012) found values of sensitivity ranging from 90-100% and specificity ranging from 1-77%.
So first you want to clear any high-risk factors which would mandate radiography
Radiography is indicated for patients who are 65 or older, patients who have paresthesias in the extremities, or if the trauma had a dangerous mechanism which are:
If these factors are not present, check if the following low-risk factors apply, allowing safe assessment of range of motion. These are:
If these do not apply, refer out for radiographs. Otherwise, continue by asking the patient to actively rotate the neck.
If they are not able to rotate 45° left and right, refer out for radiographs. If they are able to do so, then no radiographs are needed.
Another common screening tool for cervical fractures are the NEXUS criteria. If you want to screen for fractures in other body parts, check out the list below:
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