UMEM Educational Pearls

Title: C-Spine Clearance by ED Triage Nurses?

Category: Neurology

Keywords: cervical, spine, clearance, triage, nurse, trauma (PubMed Search)

Posted: 11/14/2018 by WanTsu Wendy Chang, MD
Click here to contact WanTsu Wendy Chang, MD

The Canadian C-Spine Rule (CCR) has been shown to decrease the use of cervical spine imaging in low-risk trauma patients.
While developed for use by physicians, CCR has also been validated in ED triage nurses with moderate interrater reliability (kappa 0.78) by Stiell et al. in 2010.
Stiell’s group has since implemented the use of CCR by ED triage nurses at 9 teaching hospitals in Ontario with a combined annual volume of approximately 670,000 ED visits.
180 certified nurses evaluated 1408 patients.
- 806 (57.2%) arrived with c-spine immobilization.
- 602 (42.8%) had neck pain but no immobilization.
Overall, nurses removed immobilization in 331 (41.4%) patients and applied immobilization in 203 (14.4%) patients.
Diagnostic imaging was performed in 612 (43.4%) patients and found 16 (1.1%) clinically important and 3 (0.6%) clinically unimportant injuries.
There were no missed c-spine injuries to the knowledge of the authors as the study hospitals were closely connected with the regional spine centers.
Time from nursing assessment to discharge decreased by 26.0% (3.4h vs. 4.6h)

Bottom Line: ED triage nurses can safely use the Canadian C-Spine Rule. This approach can improve patient care and decrease length of stay in the ED.

References

Stiell IG, Clement CM, O’Connor A, et al. Multicentre prospective validation of use of the Canadian C-Spine Rule by triage nurses in the emergency department. CMAJ. 2010;182(11):1173-9.
Stiell IG, Clement CM, Lowe M, et al. A multicenter program to implement the Canadian C-Spine Rule by emergency department triage nurses. Ann Emerg Med. 2018;72(4):333-41.

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