Implementation of the Canadian C-Spine Rule
Many thousands of trauma patients are seen in Canadian emergency departments each year. On rare occasions, such patients have a broken neck (cervical spine fracture) but in 98 percent of cases the xrays ordered by the doctors are normal. The total cost of inexpensive but high volume tests such as neck x-rays adds considerably to rising health care costs. In addition, these patients are often immobilized with uncomfortable backboards and collars for many hours, tying up valuable space and time in our crowded emergency departments.
This research group recently developed and tested a highly accurate and reliable guideline called the Canadian C-Spine Rule to help physicians be much more selective in their use of neck x-rays and to minimize the period of immobilization. This research project will evaluate the true effectiveness of the Rule when implemented with simple and inexpensive measures. This study will involve 14,000 patients in 12 busy emergency departments across Canada.
This Canadian C-Spine Rule is designed to allow physicians to be much more selective in their use of neck xrays without the risk of missing a fracture or dislocation of the neck and to reduce the length of time of immobilization. Widespread use of the guideline could lead to large savings for our health care systems without jeopardizing patients and could greatly expedite care of trauma patients in our crowded emergency departments.
|Study Design:||Allocation: Randomized
Endpoint Classification: Efficacy Study
Intervention Model: Single Group Assignment
Masking: Open Label
Primary Purpose: Diagnostic
|Official Title:||Implementation of the Canadian C-Spine Rule: Phase III|
- Cervical spine radiography ordering proportions [ Time Frame: 12 months ] [ Designated as safety issue: No ]The primary study outcome was the proportion of eligible patients referred for diagnostic imaging of the cervical spine. Daily patient census logs were reviewed to identify potential injury patients and patient eligibility was determined from emergency department nursing and physician records and ambulance reports. Radiology reports and census lists were reviewed to determine if cervical spine imaging was performed.
- Number of missed CSI Number of serious adverse outcomes Length of stay in ED Patient satisfaction Sustainability of the intervention Performance of the Canadian C-Spine Rule Economic evaluation measures [ Time Frame: 12 months ] [ Designated as safety issue: No ]
|Study Start Date:||January 2003|
|Study Completion Date:||January 2008|
|Primary Completion Date:||January 2008 (Final data collection date for primary outcome measure)|
We randomly allocated sites to either intervention or control. At the intervention sites, active strategies were employed to implement the rule into practice, including education, policy, and real-time reminders on radiology requisitions.
|Behavioral: Use of Xrays for diagnosis|
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Please refer to this study by its ClinicalTrials.gov identifier: NCT00290875
|Ottawa, Ontario, Canada, K1Y 4E9|
|Principal Investigator:||Ian Stiell, MD||OHRI|