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EAST guideline notes: We conditionally recommend cervical collar removal after a negative high-quality C-spine CT scan result alone.None (or 0/176) had unstable C-spine injury.Of 1800 patients, 176 patients with abnormal MRI.Review included 1800 obtunded patients generally defined as GCSEAST (Eastern Association for the Surgery of Trauma) performed systematic review in 2015.If negative CT for boney injury may clear spine unless.For significant injury CT has a sensitivity of 100% while xray has a sensitivity 36%.If unable to be cleared by CCSR or NEXUS then imaging is indicated with CT C-spine is indicated.If CCSR or NEXUS criteria is met, patient can be cleared clinically.NexusĪ single trial showed Canadian rule would pick up 312 or 313 clinically important cases, while NEXUS would miss 1 one in 10 cases Sensitivity Rotates neck 45 degrees to left and rightĬ-spine can be cleared clinically if above criteria met Canadian rule vs.Dangerous mechanism (fall>3ft/5 stairs, high speed MVC (>60mph)/rollover/ejection, bicycle crash, RV, axial load injury).Radiography is not necessary if the patient satisfies ALL of the following low risk criteria:Ĭ-spine imaging should be considered unless the patient meets all of the above low risk criteria Canadian Cervical Spine RuleĪlgorithm for evaluation of cervical spine injuries (Canadian C-spine Rule) No High Risk Factors C-spine can be clinically cleared by trained personnel.Most blunt trauma patients will be placed in a cervical collar by EMS to protect the C-spine.US and Canada with more than 13 million trauma patients per year at risk for C-spine injury.