Canadian C-Spine Rule

Determine need for c-spine imaging in alert, stable trauma patients

Indication

id: high_risk; label: Any high-risk factor? (Age ≥65, dangerous mechanism, paresthesias in extremities); type: yesno; points: 3
id: low_risk; label: Any low-risk factor allowing safe assessment? (Simple rear-end MVC, sitting in ED, ambulatory, delayed onset neck pain, no midline tenderness); type: yesno; points: 0
id: rotation; label: Able to actively rotate neck 45° left AND right?; type: yesno; points: 0

function(score, answers) { if (answers && answers.high_risk === 1) return { risk: 'High Risk', tier: 'Imaging Required', action: 'High-risk factor present. C-spine imaging required.', color: 'red' }; if (answers && answers.low_risk === 0) return { risk: 'No Low-Risk Factor', tier: 'Imaging Required', action: 'No low-risk factor present. Cannot safely assess ROM. Imaging required.', color: 'red' }; if (answers && answers.rotation === 1) return { risk: 'Low Risk', tier: 'No Imaging Needed', action: 'Can actively rotate 45°. C-spine cleared clinically. 99.4% sensitivity.', color: 'green' }; if (answers && answers.rotation === 0 && answers.low_risk === 1) return { risk: 'Cannot Rotate', tier: 'Imaging Required', action: 'Unable to rotate neck 45°. C-spine imaging required.', color: 'red' }; return { risk: 'Incomplete', tier: 'Answer All Questions', action: 'Complete all questions for assessment.', color: 'yellow' }; }

Only for GCS 15, age ≥16, non-penetrating trauma, stable patients
99.4% sensitivity for c-spine injury — slightly higher than NEXUS
If high-risk factor present → stop, get imaging
Dangerous mechanisms: fall ≥3ft/5 stairs, axial load (diving), high-speed MVC/rollover/ejection, bike/ATV crash