canadian_c_spine_rule: Canadian C-Spine Rule (CCR)

In cliot: Clinical Indices and Outcomes Tools

Canadian C-Spine Rule (CCR)

Description

Implements the Canadian C-Spine Rule to determine the need for cervical spine radiography in alert and stable trauma patients. The rule proceeds through three stages: identifying high-risk factors (mandating imaging), identifying low-risk factors (allowing range of motion assessment), and assessing the ability to actively rotate the neck.

Usage

canadian_c_spine_rule(age, dangerous_mechanism, paresthesias_extremities,
                      simple_rear_end_mva, sitting_in_ed, ambulatory_at_any_time,
                      delayed_onset_neck_pain, midline_c_spine_tenderness,
                      able_to_rotate_45_degrees)

Arguments

age	Numeric. Patient age in years. (>= 65 is a High Risk factor).
dangerous_mechanism	Numeric (0 or 1). Fall from >= 1m/5 stairs, axial load to head, high-speed MVC (>100km/h), rollover, ejection, motorized recreational vehicle, or bicycle struck/collision. (1 = Yes).
paresthesias_extremities	Numeric (0 or 1). Presence of paresthesias in extremities. (1 = Yes).
simple_rear_end_mva	Numeric (0 or 1). Simple rear-end motor vehicle collision (EXCLUDES: pushed into oncoming traffic, hit by bus/large truck, rollover, or hit by high-speed vehicle). (1 = Yes).
sitting_in_ed	Numeric (0 or 1). Patient is sitting in the emergency department. (1 = Yes).
ambulatory_at_any_time	Numeric (0 or 1). Patient has been ambulatory at any time since the injury. (1 = Yes).
delayed_onset_neck_pain	Numeric (0 or 1). Neck pain was not immediate (i.e., delayed onset). (1 = Yes).
midline_c_spine_tenderness	Numeric (0 or 1). Presence of midline cervical spine tenderness. (1 = Yes, 0 = No). Note: ABSENCE of tenderness is the low-risk factor.
able_to_rotate_45_degrees	Numeric (0 or 1). Patient is able to actively rotate neck 45 degrees to the left and right. (1 = Yes).

Value

A list containing:

Recommendation	"Radiography Indicated" or "No Radiography Needed".
Risk_Reasoning	The specific stage of the rule that determined the outcome (e.g., "High Risk", "Inability to Rotate Neck").

References

Stiell IG, Wells GA, Vandemheen KL, et al. The Canadian C-spine rule for radiography in alert and stable trauma patients. JAMA. 2001;286(15):1841-1848. doi:10.1001/jama.286.15.1841

Examples

# Example 1: High Risk (Age)
# 70yo, minor fall
canadian_c_spine_rule(70, 0, 0, 0, 1, 1, 0, 0, 1)

# Example 2: Cleared (Low Risk Factor + Rotation)
# 30yo, Simple Rear End, No midline tenderness, Can rotate
canadian_c_spine_rule(30, 0, 0, 1, 1, 1, 1, 0, 1)

# Example 3: Imaging Needed (Cannot Rotate)
# 30yo, Simple Rear End, but cannot rotate 45 degrees
canadian_c_spine_rule(30, 0, 0, 1, 1, 1, 1, 0, 0)

cliot documentation built on Dec. 1, 2025, 1:06 a.m.