📌 Key Points
- 🧠 Decision rules help: 98% of c-spine CTs are negative—rules reduce unnecessary imaging.
- 📊 Both NEXUS & CCR rule out >99% of serious injuries; CCR may lower imaging rates.
- 📏 NEXUS is simpler but excludes intoxicated patients and can’t clear midline tenderness.
- 📚 CCR is more validated, includes MOI, allows intoxication if alert, and can clear some with midline tenderness.
- 🔞 CCR excludes age <16 or >65; NEXUS has no age cutoffs but less sensitive >65.
- 💡 Bottom line: Know the strengths & limits—choose the rule that fits your patient.
- 👉 Click the link to access MDCalc’s Nexus Criteria
- 👉 Click the link to access MDCalc’s Canadian C-Spine Rules
🤕 Case
A 45 year old man presents with neck pain after a motor vehicle collision. He was a restrained driver travelling at approximately 30 MPH, and was rear-ended by another car. Airbags were deployed. He was able to walk at the scene. He denies head injury, focal weakness or paresthesias. He states he had “one beer with dinner an hour ago.” On exam, pt is GCS 15, with mild midline tenderness to palpation at C6 and C7. He has full motor strength and a nonfocal neurologic exam including normal speech and decision-making capacity. No other injuries are noted. He asks you, “Do I really need a CT Scan?”
🔨 Why Do We Need a Clinical Decision Rule?
Over 1 million blunt trauma patients visit US emergency departments each year for possible c-spine injuries. Yet, 98% of c-spine imaging shows no fracture. Using clinical decision tools can safely and significantly reduce unnecessary imaging.
🎯 Quick Hits
💬 Case Resolution
You explain to your patient that the Canadian C-Spine Rule is highly reliable-catching over 99% of serious injuries-though it might miss the tiniest ones. Satisfied, he asks to be discharged so he can make it to happy hour.
🚨 Clinical Bottom Line
Both CCR and NEXUS are effective at ruling out c-spine fractures. CCR contains more steps, but can be applied to patients who have midline tenderness on physical exam.
Post Peer Reviewed By: Marco Propersi, DO (Twitter/X: @Marco_Propersi), and Mark Ramzy, DO (X: @MRamzyDO)
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