Emergency & trauma

Canadian C-Spine Rule

Stepwise cervical imaging rule with safe sequencing of neck rotation.

Intended population: Age 16 or older, stable, alert (GCS 15), acute blunt head/neck trauma with possible cervical injury.

Dangerous mechanism: fall ≥3 ft / 5 stairs, axial load, high-speed collision >100 km/h, rollover/ejection, motorized recreation vehicle, or bicycle collision.
Low-risk factors: simple rear-end collision, sitting in ED, ambulatory at any time, delayed neck pain, or no midline tenderness. A simple rear-end collision excludes rollover, high-speed impact, a large truck/bus, or being pushed into traffic.
Do not attempt rotation when a high-risk factor is present or no low-risk factor permits assessment.

Age (years)

Blunt head/neck trauma within 48 hours, stable, GCS 15, reliable examination, and no known vertebral disease, paralysis, prior cervical surgery, or reassessment?

Dangerous mechanism as defined below?

Paresthesias in any extremity?

Sources and scoring references

Original Canadian C-Spine Rule (2001) ↗

Implementation references reviewed October 28, 2026. Verify applicability and unusual or treatment-changing results against the linked references and local guidance.