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CANADIAN CERVICAL SPINE RULE:
A 53-year old female patient was referred for physical therapy on last Thursday. The patient complained of neck pain, and reports of sleeping on two pillows the previous night. Upon examination the patient does not report of on tingling or numbness on performing the cervical compression and distraction test. The patient had the radiograph taken the previous and the referral stated evaluate and treat according.
According to Rethnam et al (2008), a cautious outlook towards neck injuries has been the norm to avoid missing cervical injuries. The patient on the above mention case had already obtained a radiography which showed absence of fractures or dislocations. However, Rethnam et al (2008) raises the question whether applying the Canadian rule for cervical spine reduces the radiography rates in alert patients with blunt trauma to the neck region? Coffey et al (2011), validates the use of Canadian rule for cervical spine in the UK emergency department setting. According to Coffey et al (2011), The incidence of fracture or cervical spine (c-spine) injury is very low, particularly in alert patients with intact neurological status. Coffey et al (2011) noted that even though the patients were alert and oriented still the patients were referred for a radiograph of the cervical spine to rule out the occurrence of "just in case" notion. Coffey et al (2011) overly cautious approach is understandable in view of the potentially devastating consequences of missing a spinal injury.
Large numbers of unnecessary c-spine radiographs add significantly to National Health Service (NHS) health costs and create unnecessary work for ED staff. They increase patient time in the ED and lead to prolonged and often unnecessary immobilization. Overdependence on investigations may also block the development of clinical judgment and compromise rather than improve patient care (Coffey et al, 2011).
This same idea can be applied to the above mention case study. If the patient showed no signs and symptoms of cervical myelopathy then the rationale of taking a radiograph does not fit in according to the Canadian Cervical Spine Rule. According the CCSR (Canadian cervical spine rule) stated in the article by Eagles et al.(2008), the following criteria's should be considered before referring the patient for a radiography.
I still don't understand why the patient was referred for radiography when the patient denies of any numbness or paresthesia. The patient herself reported the therapist that she had this problem before and that time she was asked to go for an MRI. I particularly think CCRS should be taken effectively into notion and should be practice to avoid abuse and overuse of the imaging services.
Reading to the above mention case study do you think that a radiograph was still necessary? Do you think that the physician ordered the radiograph to rule out other asymptomatic symptoms associated with the cervical spine? Do you think applying CCRS in all the patients can be beneficial or there should be general limitations to apply CCRS?
Thanks
Sweta
References:
Debra Eagles, MD, Ian G. Stiell, MD, MSc, Catherine M. Clement, RN, Jamie Brehaut, PhD, Monica Taljaard, PhD, Anne-Maree Kelly, MD, MClinEd, Suzanne Mason, MBBS, FRCS, MD, Arthur Kellermann, MD, MPH, Jeffrey J. Perry, MD, MSc. ACAD EMERG MED • December 2008, Vol. 15, No. 12.
Frank Coffey, Susanne Hewitt, Ian Stiell, Nick Howarth, Phil Miller, Cathy Clement, Paul Emberton, Abdul Jabbar. Emerg Med J 2011;28:873e876.
Ulfin Rethnam, Rajam Yesupalan & Giri Gandham (2008). BMC Med Imaging. 2008; 8: 12.
A 53-year old female patient was referred for physical therapy on last Thursday. The patient complained of neck pain, and reports of sleeping on two pillows the previous night. Upon examination the patient does not report of on tingling or numbness on performing the cervical compression and distraction test. The patient had the radiograph taken the previous and the referral stated evaluate and treat according.
According to Rethnam et al (2008), a cautious outlook towards neck injuries has been the norm to avoid missing cervical injuries. The patient on the above mention case had already obtained a radiography which showed absence of fractures or dislocations. However, Rethnam et al (2008) raises the question whether applying the Canadian rule for cervical spine reduces the radiography rates in alert patients with blunt trauma to the neck region? Coffey et al (2011), validates the use of Canadian rule for cervical spine in the UK emergency department setting. According to Coffey et al (2011), The incidence of fracture or cervical spine (c-spine) injury is very low, particularly in alert patients with intact neurological status. Coffey et al (2011) noted that even though the patients were alert and oriented still the patients were referred for a radiograph of the cervical spine to rule out the occurrence of "just in case" notion. Coffey et al (2011) overly cautious approach is understandable in view of the potentially devastating consequences of missing a spinal injury.
Large numbers of unnecessary c-spine radiographs add significantly to National Health Service (NHS) health costs and create unnecessary work for ED staff. They increase patient time in the ED and lead to prolonged and often unnecessary immobilization. Overdependence on investigations may also block the development of clinical judgment and compromise rather than improve patient care (Coffey et al, 2011).
This same idea can be applied to the above mention case study. If the patient showed no signs and symptoms of cervical myelopathy then the rationale of taking a radiograph does not fit in according to the Canadian Cervical Spine Rule. According the CCSR (Canadian cervical spine rule) stated in the article by Eagles et al.(2008), the following criteria's should be considered before referring the patient for a radiography.
I still don't understand why the patient was referred for radiography when the patient denies of any numbness or paresthesia. The patient herself reported the therapist that she had this problem before and that time she was asked to go for an MRI. I particularly think CCRS should be taken effectively into notion and should be practice to avoid abuse and overuse of the imaging services.
Reading to the above mention case study do you think that a radiograph was still necessary? Do you think that the physician ordered the radiograph to rule out other asymptomatic symptoms associated with the cervical spine? Do you think applying CCRS in all the patients can be beneficial or there should be general limitations to apply CCRS?
Thanks
Sweta
References:
Debra Eagles, MD, Ian G. Stiell, MD, MSc, Catherine M. Clement, RN, Jamie Brehaut, PhD, Monica Taljaard, PhD, Anne-Maree Kelly, MD, MClinEd, Suzanne Mason, MBBS, FRCS, MD, Arthur Kellermann, MD, MPH, Jeffrey J. Perry, MD, MSc. ACAD EMERG MED • December 2008, Vol. 15, No. 12.
Frank Coffey, Susanne Hewitt, Ian Stiell, Nick Howarth, Phil Miller, Cathy Clement, Paul Emberton, Abdul Jabbar. Emerg Med J 2011;28:873e876.
Ulfin Rethnam, Rajam Yesupalan & Giri Gandham (2008). BMC Med Imaging. 2008; 8: 12.
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