For alert (GCS 15) and stable trauma patients where cervical spine injury is a concern. Three questions in order: high-risk factor, low-risk factor, active rotation.
What you enter
High risk: age ≥65
High risk: dangerous mechanism (fall from ≥0.9 m or 5 stairs, axial load to the head such as diving, high-speed motor vehicle collision >100 km/h, rollover, ejection, motorised recreational vehicle, bicycle collision)
High risk: paraesthesias in the extremities
Low risk: simple rear-end motor vehicle collision (not pushed into oncoming traffic, hit by a bus or large truck, rollover, or hit by a high-speed vehicle)
Low risk: sitting position in the emergency department
Low risk: walking at any time since the injury
Low risk: delayed onset of neck pain (not immediate)
Low risk: no midline cervical spine tenderness
Active neck rotation, 45° left and right: Not assessed yet / Able / Unable
FORMULAAny high-risk factor → radiography. Else no low-risk factor → radiography. Else unable to actively rotate 45° left and right → radiography. Else no radiography.
SourceStiell IG et al. The Canadian C-spine rule for radiography in alert and stable trauma patients. JAMA 2001;286:1841-8NoteNot applicable if: non-trauma case, GCS <15, unstable vital signs, age <16, acute paralysis, known vertebral disease, or previous cervical spine surgery. Definitions checked against the rule card printed in Stiell IG et al. BMJ 2009;339:b4146.ReviewedFormula and thresholds checked against the source on 2026-09-28. If the source updates, this line will say so.
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