The Canadian C-Spine Rule aims to provide emergency room physicians with better and more efficient protocols for assessing neck injuries. The Canadian C-Spine Rule will greatly reduce the taking of unnecessary and time-consuming X-rays, while ensuring that neck injuries are accurately diagnosed. This means lesser wait times for others waiting for X-rays, better patient flow through emergency rooms, and lower healthcare costs.
The Issues around X-rays
Every year in Canada and the United States, over 13 million people are treated for possible traumatic neck injuries.
MRIs, CT scans, and standard X-rays all take time. The more X-rays prescribed, the more crowded waiting lists get, and the longer it can take to commence treatment because of the time needed to wait for evaluation of the X-rays. Of course, the X-rays are needed to ensure that physicians can examine every possible area of damage so they "don't miss anything." The Canadian C-Spine Rule will revolutionize the way physicians look at X-rays as a diagnostic tool for neck injuries.
In a time where MRIs and CT scans are being more and more requested to help assess more and more injuries, there is a push to streamline which X-rays are actually necessary. Part of the wait time issue for these kinds of diagnostic tests in Canada is because doctors are prescribing MRIs and CT scans for things the may not really require diagnostic imaging. It is speculated that many doctors refer for diagnostic imaging scans when many of the symptoms can be diagnosed through basic physiological examination.
In the area of spinal cord injuries affecting the neck, though, it is critical that nothing be missed. Which X-rays are actually necessary for diagnosing neck injuries, and how many are actually required? Those are the questions that this study sought to answer.
The Study
The study was conducted by clinical trials in 12 hospitals across Canada. Their specific goal was to reduce the amount of X-rays and diagnostic imaging prescribed without compromising a physician's ability to effectively diagnose the presence of and extent of neck injuries.
This study was led by Dr. Ian Stiell of the Ottawa Hospital Research Institute (OHRI) and published in the October 2009 issue of the British Medical Journal. It was funded by the Canadian Institutes of Health Research and involved nearly 12,000 patients.
Six hospitals were designated to use the C-Spine rule, while the other six were designated to continue with what they had always done. The results showed that the first group of hospitals saw a decrease in their use of neck X-rays by 12.8 per cent over the course of a year. The remaining six hospitals saw a 12.5 per cent increase in their neck X-rays over the same amount of time. The catch - no serious neck injuries were missed in either group. The final imaging rates reported were significantly lower at the intervention hospital test sites than in most American hospitals. So this new protocol could certain have world-wide implications.
The Canadian C-Spine Rule works through ordinary Q&A and physiological examination, and specifically asks three questions:
1) Are there any high-risk factors that warrant use of diagnostic imaging? Those factors include: patients over the age of 65, patient presentation to emergency department with abnormal feelings in extremities; dangerous mechanism of injury (eg: motor vehicle accident).
2) Are there any low-risk factors that would allow safe assessment of range of motion? (eg: minor rear-end collision (whiplash); is the patient able to sit up in the ER; delayed onset of neck pain and absence of tenderness in the neck midline)
3) Is the patient able to rotate their neck 45 degrees to the left or right?
If the patient, through these questions, is deemed low-risk then they would not receive C-spine radiography.
This rule is not the first for Canadian researchers. In fact, Canadian researchers at OHRI and the University of Ottawa are known as world leaders in developing clinical decision rules: Ottawa Ankle Rules; Ottawa Knee Rules; Canadian CT Head Rules, and the Wells Rules for Diagnosing Deep Vein Thrombosis and Pulmonary Embolism are in use around the world. The Ottawa Ankle Rule has even been mentioned on the popular TV show, ER.
It is hoped that as physicians and hospitals start implementing these protocols, there will be less wait times for patients who are at higher risk and require diagnostic imaging, and there will be less expense for hospitals.
Sources: www.ohri.ca (Ottawa Hospital Research Institute)