CCR · Canadian C-Spine Rule

Three steps, in order, for an alert and stable trauma patient.

1. Any high-risk factor that mandates imaging? Age 65 or over · a dangerous mechanism · paraesthesia in the extremities. Yes → image.
2. Any low-risk factor that allows safe assessment of range? Simple rear-end collision · sitting in the department · ambulatory at any time · delayed onset of neck pain · no midline tenderness. No → image.
3. Can they actively rotate 45° left and right? No → image.

Any patient presenting after a traumatic neck injury — most often whiplash on an outpatient list. As with the Ottawa rules, on placement you are usually applying it after the fact: did this patient need a film, and does the absence of one still sit comfortably?

Teach it beside NEXUS. Two rules, same question, different structures — the comparison is the lesson.

Not scored — it is an ordered algorithm and the order matters. Never test rotation until step 2 has given you permission to.

Anything about the source of ongoing pain. It is a fracture and instability screen, nothing more. And it does not screen for cervical arterial dysfunction — that is a separate history and examination, and it is on its own page.

Pair it with: NDI or the Whiplash Disability Questionnaire for baseline function, and a proper neurological examination recording power, reflexes and sensation.

A rule-out designed for very high sensitivity in alert, stable trauma. No verified accuracy figure is carried in our library and none is printed here.

It does not apply to non-trauma neck pain, to patients who are not alert (GCS below 15), to unstable vital signs, to age under 16, to known vertebral disease, or to a previous cervical spine surgery.