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Implementation of the Canadian C-Spine Rule

The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been evaluated by the U.S. Federal Government. Read our disclaimer for details. Identifier: NCT00290875
Recruitment Status : Completed
First Posted : February 13, 2006
Last Update Posted : April 22, 2015
Canadian Institutes of Health Research (CIHR)
Information provided by (Responsible Party):
Dr. I. Stiell, Ottawa Hospital Research Institute

Brief Summary:

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.

Condition or disease Intervention/treatment Phase
Cspine Injury Behavioral: Use of Xrays for diagnosis Phase 3

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Study Type : Interventional  (Clinical Trial)
Actual Enrollment : 11824 participants
Allocation: Randomized
Intervention Model: Single Group Assignment
Masking: None (Open Label)
Primary Purpose: Diagnostic
Official Title: Implementation of the Canadian C-Spine Rule: Phase III
Study Start Date : January 2003
Actual Primary Completion Date : January 2008
Actual Study Completion Date : January 2008

Resource links provided by the National Library of Medicine

Drug Information available for: X-Rays

Arm Intervention/treatment
Arm 1
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

Primary Outcome Measures :
  1. Cervical spine radiography ordering proportions [ Time Frame: 12 months ]
    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.

Secondary Outcome Measures :
  1. 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 ]

Information from the National Library of Medicine

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Ages Eligible for Study:   16 Years and older   (Child, Adult, Older Adult)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   Yes

Inclusion Criteria:All alert, stable adults presenting to the study hospital EDs after sustaining acute blunt trauma to the head or neck will be eligible and consecutive eligible trauma patients will be entered into the study. Patient eligibility will be determined based on these criteria at the time of arrival in the ED. a) "Trauma to the head and neck" will include patients with either: i) neck pain with any mechanism of injury (subjective complaint by the patient of any pain in the posterior midline or posterolateral aspect of the neck), or ii) no neck pain but all of: some visible injury above the clavicles, has not been ambulatory at any time, and associated with a high risk mechanism of injury (motor vehicle collision including motorcycle, pedestrian struck by a motor vehicle, bicycle collision, fall greater than or equal to 3 feet or 5 steps, diving, or contact sport with axial load to head and neck). b) "Alert" is defined as a Glasgow Coma Scale103 score of 15 (converses, fully oriented, and follows commands). c) "Stable" refers to normal vital signs as defined by the Revised Trauma Score24 (systolic blood pressure 90 mm Hg or greater and respiratory rate between 10 and 24 breaths per minute). d) "Acute" refers to injury within the past 48 hours.


Exclusion Criteria:a) Patients under the age of 16 years, b) Patients who do not satisfy the definition of "trauma to the head and neck" as defined above (for example, patients with neither neck pain nor visible injuries above the clavicles will be excluded), c) Patients with Glasgow Coma Scale score less than 15, d) Patients with unstable vital signs (systolic BP < 90; respiratory rate less than 10 or more than 24), e) Patients whose injury occurred more than 48 hours previously, f) Patients with penetrating trauma from stabbing or gunshot wound, g) Patients with acute paralysis (paraplegia, quadriplegia), h) Patients with known vertebral disease (ankylosing spondylitis, rheumatoid arthritis, spinal stenosis, or previous cervical spine surgery), or i) Patients who return for reassessment of the same injury.


Information from the National Library of Medicine

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.

Please refer to this study by its identifier (NCT number): NCT00290875

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Canada, Ontario
Ottawa Hospital
Ottawa, Ontario, Canada, K1Y 4E9
Sponsors and Collaborators
Ottawa Hospital Research Institute
Canadian Institutes of Health Research (CIHR)
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Principal Investigator: Ian Stiell, MD OHRI
Publications of Results:
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Responsible Party: Dr. I. Stiell, Senior Scientist, Ottawa Hospital Research Institute Identifier: NCT00290875    
Other Study ID Numbers: 2002174-01H, MOP62795
First Posted: February 13, 2006    Key Record Dates
Last Update Posted: April 22, 2015
Last Verified: April 2015
Keywords provided by Dr. I. Stiell, Ottawa Hospital Research Institute:
cspine injury
clinical impact