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new england journal



original article

The Canadian C-Spine Rule versus the NEXUS Low-Risk Criteria in Patients with Trauma
Ian G. Stiell, M.D., M.Sc., Catherine M.Clement, R.N., R. Douglas McKnight, M.D., Robert Brison, M.D., M.P.H., Michael J. Schull, M.D., M.Sc., Brian H. Rowe, M.D., M.Sc., James R. Worthington, M.B., B.S., Mary A. Eisenhauer, M.D., Daniel Cass,M.D., Gary Greenberg, M.D., Iain MacPhail, M.D., M.H.Sc., Jonathan Dreyer, M.D., Jacques S. Lee, M.D., Glen Bandiera, M.D., Mark Reardon, M.D., Brian Holroyd, M.D., Howard Lesiuk, M.D., and George A.Wells, Ph.D.


From the Departments of Emergency Medicine (I.G.S., J.R.W., G.G., M.R.) and Epidemiology and Community Medicine (G.A.W.), the Clinical Epidemiology Program(C.M.C.), and the Division of Neurosurgery (H.L.), University of Ottawa, Ottawa, Ont.; the Division of Emergency Medicine, University of British Columbia, Vancouver (R.D.M., I.M.); the Department ofEmergency Medicine, Queens University, Kingston, Ont. (R.B.); the Division of Emergency Medicine, University of Toronto, Toronto (M.J.S., D.C., J.S.L., G.B.); the Division of Emergency Medicine, Universityof Alberta, Edmonton (B.H.R., B.H.); and the Division of Emergency Medicine, University of Western Ontario, London (M.A.E., J.D.) — all in Canada. Address reprint requests to Dr. Stiell at theClinical Epidemiology Unit, F657, Ottawa Health Research Institute, 1053 Carling Ave., Ottawa, ON K1Y 4E9, Canada. N Engl J Med 2003;349:2510-8.
Copyright © 2003 Massachusetts Medical Society.

TheCanadian C-Spine (cervical-spine) Rule (CCR) and the National Emergency X-Radiography Utilization Study (NEXUS) Low-Risk Criteria (NLC) are decision rules to guide the use of cervical-spine radiography inpatients with trauma. It is unclear how the two decision rules compare in terms of clinical performance.

We conducted a prospective cohort study in nine Canadian emergency departments...