NICE criteria C spine
- Note: If the person is unable to understand commands or open their mouth, a peg view may be omitted.
- Predisposing condition: collagen vascular disease, osteogenesis imperfecta, axial spondyloarthritis
Age Group | 16 and over | |
16 and over | HI + any High-risk factors • GCS ≤ 12 • Intubated • Urgent diagnosis needed (spinal manipulation) • Blunt polytrauma • Clinical suspicion of C spine injury + any of the following ◦ >65 ◦ Dangerous mech ◦ Neuro deficit (motor/sensory) HI + Neck pain/tenderness + no high risk features • Not safe to assess neck ROM • Neck ROM < 45 degree rotation • Predisposing condition-higher risk of injury to the cervical spine | CT cervical spine scan within 1 hour |
Under 16 | High-risk factors • GCS ≤ 12, • Intubated, • Neuro deficit (motor/sensory)urgent diagnosis needed, • Clinical suspicion with other scans, • Strong suspicion despite normal X-rays, • Difficult/inadequate X-rays, • Significant bony injury | CT cervical spine scan within 1 hour |
Under 16 | Head injury + neck pain/tenderness + no CT indications • Dangerous mechanism of injury • Not safe to assess neck ROM • Neck ROM < 45 degree rotation • Predisposing condition-higher risk of injury to the cervical spine | 3-view cervical spine X-rays within 1 hour |
Canadian C-spine rules
- Can be applied to stable trauma patients with a GCS 15/15 to determine the need for imaging based on the
- Presence/absence of high risk factors necessitating radiography
- (Age > 65, significant mechanism, paresthesias in extremities),
- Presence or absence of low-risk factors allowing safe assessment of cervical ROM
- Simple rear-end collision
- Sitting up in ED,
- Delayed onset of neck pain
- Absence of midline cervical tenderness
- If low risk factors are present the for assessment of cervical ROM
- The ability to rotate neck actively 45° to right and left.
- Imaging would need to be performed if
(i) High risk factors are present
(ii) Low-risk factors are absent or
(iii) If low-risk factors present but the physician is unable to complete the range of motion assessment.
Cervical spine imaging in children: indications
Do not image cervical spine < 3 years of age who have experienced trauma and who | Do not image cervical spine > 3 years of age who have experienced trauma and who |
Have a GCS > 13, | Are alert, |
Have no neurological deficit, | Have no neurological deficit, |
Have no midline cervical tenderness, | Have no midline cervical tenderness, |
Have no painful distracting injury, | Have no painful distracting injury, |
Are not intoxicated, | Do not have unexplained hypotension, |
Do not have unexplained hypotension (i.e. due to SCI), | And are not intoxicated. |
And do not have motor vehicle collision (MVC), a fall from a height > 10 ft, or non-accidental trauma (NAT) as a known or suspected mechanism of injury. | ㅤ |