The Canadian C-spine rule safely reduces imaging rates for cervical spine injuries.

Question: Does implementation of the Canadian C-spine rule in emergency departments reduce the proportion of patients referred for diagnostic imaging of the cervical spine without a concurrent increase in unidentified cervical spine injuries or serious adverse outcomes? Design: Matched pair cluster randomised trial. Setting: 12 emergency departments of teaching and community hospitals in Canada. Participants: 11 824 patients with a Glasgow Coma Scale score of 15, normal vital signs, and who had sustained within the previous 48 hours either blunt trauma to the head or neck, or a visible injury above the clavicles and a mechanism of injury that was considered dangerous. Patients were excluded if they were under the age of 16, had a penetrating trauma, acute paralysis or known vertebral disease, or were a return patient for reassessment of injury. Randomisation of 11 824 participants allotted 6895 to the intervention group and 4929 to a control group. Interventions: The Canadian C-spine rule was implemented in the 6 intervention group hospital sites using three strategies: (1) policy agreement among physicians on ordering cervical spine imaging, (2) education initiatives including distribution of manuscripts, The Canadian C-spine rule safely reduces imaging rates for cervical spine injuries