Clinician’s Corner: The Canadian Cervical Spine Rule


  • Allan Lai
  • Monique McLaughlin
  • Nicole Cook



A 44-year-old driver of a small sedan self-presents to your emergency department (ED) triage area indicating they developed a stiff neck 30 minutes after they were rear-ended by a small van when they were stopped at a traffic light. The rear bumper of the patient’s vehicle is slightly dented, and there is scuffing to the front bumper of the van. No airbags were deployed and the driver of the sedan did not hit their head. The van was estimated to be travelling between 10-20 km/h at the time of impact. The patient self-extricated from their vehicle and was ambulatory at the scene. Currently, the patient is alert, oriented, and in no distress. The patient denies paresthesia, has no midline cervical spine (c-spine) tenderness, and is able to actively rotate their neck 45° left and right.


Bandiera, G., Stiell, I. G., Wells, G. A., Clement, C., De Maio, V., Vandemheen, K. L., Greenberg, G. H., Lesiuk, H., Brison, R., Cass, D., Dreyer, J., Eisenhauer, M. A., Macphail, I., McKnight, R. D., Morrison, L., Reardon, M., Schull, M., Worthington, J., & Canadian C-Spine and CT Head Study Group. (2003). The Canadian C-spine Rule performs better than unstructured physician judgment. Annals of Emergency Medicine, 42(3), 395–402.

Kelly, A., Bradshaw, L., & Kerr, D. (2004) Can nurses apply the Canadian C-Spine Rule? A pilot study. Canadian Journal of Emergency Medicine, 6(3), 161–164.

Kwan, I., Bunn, F., & Roberts, I. (2001). Spinal immobilisation for trauma patients. The Cochrane Database of Systematic Reviews, 2001(2), Article CD002803.

Lai, A. P., & Paquin, R. C. (Hosts). (2019). Ep. 11 – ResusX Series – Hard collar facts with the rebel, Salim Rezaie [Audio podcast episode]. In Resus Tonight with Allan and Rob. Buzzsprout.

Ottawa Hospital Research Institute. (n.d.). Canadian cervical spine rule.

Rezaie, S. R. (2017, August 7). Spinal immobilization in trauma patients. REBELEM.

Stiell, I. G., Clement, C. M., Lowe, M., Sheehan, C., Miller, J., Armstrong, S., Bailey, B., Posselwhite, K., Langlais, J., Ruddy, K., Thorne, S., Armstrong, A., Dain, C., Perry, J. J., & Vaillancourt, C. (2018). A multicenter program to implement the Canadian c-spine rule by emergency department triage nurses. Annals of Emergency Medicine, 72(4), 333–341.

Stiell, I. G., Clement, C. M., McKnight, R. D., Brison, R., Schull, M. J., Rowe, B. H., Worthington, J. R., Eisenhauer, M. A., Cass, D., Greenberg, G., MacPhail, I., Dreyer, J., Lee, J. S., Bandiera, G., Reardon, M., Holroyd, B., Lesiuk, H., & Wells, G. A. (2003). The Canadian C-spine Rule versus the NEXUS low-risk criteria in patients with trauma. New England Journal of Medicine, 349(26), 2510–2518.

Stiell, I. G., Clement, C. M., O’Connor, A., Davies, B., Leclair, C., Sheehan, P., Clavet, T., Beland, C., MacKenzie, T., & Wells, G. A. (2010). Multicentre prospective validation of use of the Canadian C-Spine Rule by triage nurses in the emergency department. Canadian Medical Association Journal, 182(11), 1173–1179.

Stiell, I. G., Wells, G. A., Vandemheen, K. L., Clement, C. M., Lesiuk, H., De Maio, V. J., Laupacis, A., Schull, M., McKnight, R. D., Verbeek, R., Brison, R., Cass, D., Dreyer, J., Eisenhauer, M. A., Greenberg, G. H., MacPhail, I., Morrison, L., Reardon, M., & Worthington, J. (2001). The Canadian C-Spine Rule for radiography in alert and stable trauma patients. JAMA, 286(15), 1841–1848.

Vaillancourt, C., Stiell, I. G., Beaudoin, T., Maloney, J., Anton, A. R., Bradford, P., Cain, E., Travers, A., Stempien, M., Lees, M., Munkley, D., Battram, E., Banek, J., & Wells, G. A. (2009). The out-of-hospital validation of the Canadian C-Spine Rule by paramedics. Annals of Emergency Medicine, 54(5), 663–671.



How to Cite

Lai, A., McLaughlin, M., & Cook, N. (2022). Clinician’s Corner: The Canadian Cervical Spine Rule. Canadian Journal of Emergency Nursing, 45(2), 5–7.



Peer Reviewed Articles