Date of Graduation

Spring 3-1-2011

Degree Type

Capstone Project

Degree Name

Master of Science in Physician Assistant Studies

First Advisor

James Ferguson

Second Advisor

Torry Cobb


Background: Despite a small percentage of true cervical spine injuries, a high number of the five million patients presenting to emergency departments with suspected cervical spine injuries undergo x-ray or computed tomography to rule out injury. High volume radiographic imaging can lead to higher medical costs as well as the potential for increased risk of cancer in overly exposed patients. The Canadian C-Spine Rule (CCR) is a clinical decision or prediction rule developed in Canada that is used to detect acute cervical spine injury. The objective of this systematic review is to determine if the use of the CCR, results in decreased radiographic imaging of the cervical spine versus unstructured physician judgment.

Methods: An extensive search of the literature was conducted using MEDLINE, CINAHL, and Pubmed. Four studies were selected that met the inclusion and exclusion criteria.

Results: All of the studies reviewed concluded that the CCR was better than unstructured physician judgment at reducing unnecessary radiographic imaging, and the CCR was more sensitive and specific than unstructured physician judgment at detecting cervical spine injury.

Conclusion: The CCR is superior to unstructured physician judgment in the reduction of unnecessary radiographic imaging in stable, alert adults with cervical-spine injury. It is also considered a more sensitive and specific tool than relying on individual physician judgment alone.

S. Goddard Poster.ppt (528 kB)