Canadian C-Spine Rule — JoyShine Medical

Canadian C-Spine Rule (CCR)

Three-step decision rule that determines whether cervical-spine imaging is required after acute blunt trauma in alert (GCS 15) and stable adults, using high-risk factors, low-risk factors, and active 45° neck rotation.

Eligibility gate

All eligibility criteria met (alert / GCS 15, stable, blunt trauma, < 48 h, age ≥ 16, no exclusion) One or more exclusion present (rule not applicable)

Step 1 high-risk: Age ≥ 65 years

No Yes

Step 1 high-risk: Dangerous mechanism (fall ≥ 3 ft / 5 stairs; axial load to head; high-speed MVC > 100 km/h, rollover, or ejection; motorized recreational vehicle; bicycle collision)

No Yes

Step 1 high-risk: Paresthesias in the extremities

No Yes

Step 2 low-risk: Simple rear-end collision (excludes pushed into oncoming traffic, hit by bus / large truck, rollover, hit by high-speed vehicle)

No Yes

Step 2 low-risk: Sitting position in the ED

No Yes

Step 2 low-risk: Ambulatory at any time since injury

No Yes

Step 2 low-risk: Delayed (not immediate) onset of neck pain

No Yes

Step 2 low-risk: Absence of midline cervical-spine tenderness

No Yes

Step 3: Able to actively rotate the neck 45° to the LEFT and RIGHT (assessed only if Step 1 is negative AND at least one Step 2 low-risk factor is present)

Not assessed Unable Able