This
is for informational purposes only. This is not to be interpreted
as “medical advice”.
Ralph and I get asked quite frequently how do we treat patients without imaging capabilities. For those working ER in facilities with imaging capabilities, obtaining x-rays/CT Scans/etc is not an issue. However, when you work in rural or frontier areas imaging may not be obtainable without involving enormous transportation costs. So, today we are sharing some guidelines for determining the necessity and/or urgency of obtaining imaging for certain injuries.
Canadian C-Spine Rule
The "2 and 6 rule" in the context of C-spine
fractures refers to the Canadian C-Spine Rule, which uses a system where if
a patient meets two high-risk criteria OR a single high-risk criterion with six
low-risk criteria then cervical spine imaging is recommended to check for
potential fractures; essentially indicating a need for further
investigation to rule out a C-spine injury.
Key points about the Canadian C-Spine Rule:
High-risk factors
(mandate imaging):
· Age
greater than 65 years
· Dangerous
mechanism of injury (e.g., significant fall, high-impact collision)
· Numbness
or tingling in extremities (paresthesia)
· Low-risk factors (allow
for clinical assessment without imaging):
· Simple
rear-end collision.
· Sitting
position in the emergency department.
· Able
to walk at any time since the injury.
· Delayed
onset of neck pain.
· Absence
of midline cervical spine tenderness.
NEXUS Criteria
What is the Nexus criteria?
NEXUS (National Emergency X-Radiography Utilization Study) is a set of validated criteria used to decide which trauma patients do not require cervical spine imaging. Trauma patients who do not require cervical spine imaging require all of the following: alert and stable. no focal neurologic deficit.
NEXUS Criteria for C-Spine Imaging
Clears patients from cervical spine fracture clinically, without imaging.
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