Canadian C-Spine Rule
Three ordered steps; active rotation offered only when permitted.
Canadian C-Spine Rule
Principle
Blunt head/neck trauma within ≤48 h, age ≥16 years, GCS15, normal vital signs (study: SBP >90mmHg, RR10–24/min), with neck pain or, without pain, visible injury above the clavicles + inability to walk + dangerous mechanism. Outside rule: trivial trauma, penetrating trauma, acute paralysis, known spinal disease (including cervical surgery), pregnancy or reassessment of the same injury. Respect the steps; never request rotation with high risk or without a low-risk factor.
Scope
Blunt head/neck trauma within ≤48 h, age ≥16 years, GCS15, normal vital signs (study: SBP >90mmHg, RR10–24/min), with neck pain or, without pain, visible injury above the clavicles + inability to walk + dangerous mechanism. Outside rule: trivial trauma, penetrating trauma, acute paralysis, known spinal disease (including cervical surgery), pregnancy or reassessment of the same injury. Respect the steps; never request rotation with high risk or without a low-risk factor.
Interpretation limits
Blunt head/neck trauma within ≤48 h, age ≥16 years, GCS15, normal vital signs (study: SBP >90mmHg, RR10–24/min), with neck pain or, without pain, visible injury above the clavicles + inability to walk + dangerous mechanism. Outside rule: trivial trauma, penetrating trauma, acute paralysis, known spinal disease (including cervical surgery), pregnancy or reassessment of the same injury. Respect the steps; never request rotation with high risk or without a low-risk factor.
Formula and logic
1. High risk present → imaging, no rotation. 2. Otherwise, no low risk → imaging, no rotation. 3. Otherwise, active rotation ≥45° both sides: if possible, imaging not indicated by the rule; otherwise, imaging indicated.
Interpretation
- Imaging not indicated by the rule
- No high risk, at least one low-risk factor and observed active rotation ≥45° left and right.
- Imaging indicated by the rule
- High risk, no low-risk factor, or insufficient active rotation after the permitted steps.
Definition version : 0.1.0
Sources
- Stiell et al. · JAMA — The Canadian C-Spine Rule for Radiography in Alert and Stable Trauma Patients
2001-10-17 · Full original article; methods, criteria, definitions and discussion reread on 2026-10-06. Three steps; active rotation45° both sides only after the safety steps, without an added “pain-free” requirement.