Canadian C-Spine Rule
Three-step decision rule to determine need for cervical spine imaging in alert, stable trauma patients
- Highest activation tier
- Mandatory
- How it is scored
- Scored in code; a stated value is compared only from the structured summary or a supplied value
- Scoring type
- classification
- Care settings
- Emergency department
When it activates
Scribeable activates a calculator from the encounter. The Canadian C-Spine Rule can activate when the transcript or pasted chart context documents any of these:
- Cervical spine injury evaluation
- Neck pain after trauma
- Motor vehicle collision assessment
- C-spine clearance decision
- Trauma with neck pain
A coded diagnosis can also activate it. ICD-10 prefixes carried by the registry: S12, S13, S14.
Note-type scope: it activates on notes whose subject resolves to emergency medicine, hospital medicine. A note that resolves to another subject does not carry it even when the clinician's specialty matches; a note with no resolvable subject (a generic consultation) falls back to the specialty match.
Inputs the note needs
3 inputs. Each is resolved from the transcript, the pasted chart context and charted labs; an input marked "asks you" is requested as a clarification when it is undocumented.
| Input | Type | Unit / options | Guidance |
|---|---|---|---|
| High-risk factors: age ≥65, dangerous mechanism, or paresthesias in extremities | history | ||
| Low-risk factors: simple rear-end MVC, sitting position in ED, ambulatory at any time, delayed onset neck pain, absence of midline c-spine tenderness | history | ||
| Able to actively rotate neck 45° left and right | exam |
Scoring
Step 1: Any high-risk factor (age ≥65, dangerous mechanism, paresthesias) → imaging. Step 2: Any low-risk factor (simple rear-end MVC, sitting in ED, ambulatory, delayed neck pain, no midline tenderness) → assess ROM. Step 3: Able to rotate neck 45° → no imaging needed. Score: 0 = no imaging needed, 1 = imaging indicated.
Interpretation
Applicable to alert (GCS 15), stable trauma patients. High-risk factors mandate imaging. Low-risk factors allow ROM assessment. Full active rotation (45° bilateral) clears the c-spine. Sensitivity 99.4% for clinically significant c-spine injury.
Evidence
Sources carried in Scribeable's citation registry for this calculator; guideline version: Stiell IG et al. 2001.
- Stiell IG et al. The Canadian C-Spine Rule for radiography in alert and stable trauma patientsStiell et al. (Canadian C-Spine) 2001 · 2001 · Level I · link last verified 2026-03-28
How Scribeable handles it in the note
When an encounter activates the Canadian C-Spine Rule at the mandatory tier, Scribeable resolves its inputs from the transcript, the pasted chart context and any charted labs, and asks you for a missing input you can supply before the note is finalised. Bedside-exam and separately ordered study values are not requested one input at a time; a calculator that carries a combined clarification question may still put that single question to you.
The score is computed in code from the resolved inputs, not recalled by the language model. A stated Canadian C-Spine Rule value is compared against the computed one when the draft's structured summary carries it; a disagreement found there is flagged to the second drafting pass, which is instructed to correct the score and its interpretation, unless Scribeable has supplied the computed value to that pass, in which case the value the draft writes is checked against the supplied one and a detected difference is shown beside the note for you to adjudicate rather than silently rewritten.
Classified as a mandatory rule-out score: a missed result carries acute harm, so the activation filter never approves it on uncertainty.
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