Published 29 October 2009, doi:10.1136/bmj.b4139
Cite this as: BMJ 2009;339:b4139

Editorials

Prediction rules in cervical spine injury

Can reduce unnecessary imaging, without missing fractures or increasing adverse events

The first 150 words of the full text of this article appear below.

"Clinical prediction rules" or "decision rules" are designed to suggest a pathway of probability of a pathological condition and help the clinician choose a diagnostic or therapeutic course of action. The rules reduce the uncertainty inherent in medical practice—for example, in emergency medicine and trauma—by appraising clinical findings to make predictions. Because these rules affect patient care and health costs, they must be carefully evaluated before implementation. For this purpose, guidance and methodological standards exist for users and developers of clinical prediction rules.^{1 2} In the linked cluster randomised controlled study (doi:10.1136/bmj.b4146),³ Steill and colleagues assess the effectiveness of a knowledge translation strategy to implement the validated Canadian c-spine rule in 12 emergency departments in Canada.

Specific algorithms and prediction rules for the initial assessment of patients with cervical spine injury have been proposed in the literature. Since the early 1990s, the National Emergency X-Radiography Utilization Study’s low risk . . . [Full text of this article]

¹ Medical Interventional and Surgical Spine Center, Cleveland Clinic Florida, 2950 Cleveland Clinic Blvd, Weston FL 33331, USA, ² Orthopaedic Department of Keio University Hospital, 35 Shinanomachi Shinjuku-ku, Tokyo, Japan 160-8582

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Relevant Article

Implementation of the Canadian C-Spine Rule: prospective 12 centre cluster randomised trial

Ian G Stiell, Catherine M Clement, Jeremy Grimshaw, Robert J Brison, Brian H Rowe, Michael J Schull, Jacques S Lee, Jamie Brehaut, R Douglas McKnight, Mary A Eisenhauer, Jonathan Dreyer, Eric Letovsky, Tim Rutledge, Iain MacPhail, Scott Ross, Amit Shah, Jeffrey J Perry, Brian R Holroyd, Urbain Ip, Howard Lesiuk, and George A Wells
BMJ 2009 339: b4146. [Abstract] [Full Text] [PDF]

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