Evidence map›Paper›PMID 32965634›Full record

ArticleLa Radiologia medica2021

Value of Canadian C-spine rule versus the NEXUS criteria in ruling out clinically important cervical spine injuries: derivation of modified Canadian C-spine rule.

Parisa Ghelichkhani, Kavous Shahsavarinia, Afshin Gharekhani, Ali Taghizadieh, Alireza Baratloo, Fattah Hama Rahim Fattah, Najmeh Abbasi, Mohammed I M Gubari, Gholamreza Faridaalee, Hossein Dinpanah and 6 more

Abstract readComparative StudyMulticenter Study
PubMed Publisher
In one paragraph

Article in La Radiologia medica, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 8 papers, 2 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
8citing papers in PubMed, 2 pooled it
1.8field-weighted citation impact, top 14% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

8 citing papers in PubMed, 2 syntheses or guidelines pooled it, 18 citations in OpenAlex.

  1. Pooled it
  2. Evidence for the use of spinal collars in stabilising spinal injuries in the pre-hospital setting in trauma patients: a systematic review.European journal of trauma and emergency surgery : official publication of the European Trauma Society · 2022
    Pooled it
  3. Article
  4. A Case Report of an Unstable C-spine Fracture in the Emergency Department.Journal of education & teaching in emergency medicine · 2025
    Article
  5. Review
  6. Review
  7. Article
  8. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

16 authors at 11 institutions in 3 countries.

Parisa GhelichkhaniDepartment of Intensive Care Nursing, School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran.
Kavous ShahsavariniaRoad Traffic Injury Research Center, Tabriz University of Medical Sciences, Tabriz, Iran.
Afshin GharekhaniDepartment of Clinical Pharmacy (Pharmacotherapy), Drug Applied Research Center, Tabriz University of Medical Sciences, Tabriz, Iran.
Ali TaghizadiehTuberculosis and Lung Research Center, Tabriz University of Medical Sciences, Tabriz, Iran.
Alireza BaratlooPre-Hospital and Hospital Research Center, Tehran University of Medical Sciences, Tehran, Iran.
Fattah Hama Rahim FattahCommunity Medicine, College of Medicine, University of Sulaimani, Sulaimani, Iraq.
Najmeh AbbasiDepartment of Emergency Medicine, Maragheh University of Medical Sciences, Maragheh, Iran.
Mohammed I M GubariCommunity Health Department, Technical College of Health, Sulaimani Polytechnic University, Sulaimani, Iraq.
Gholamreza FaridaaleeCommunity Health Department, Technical College of Health, Sulaimani Polytechnic University, Sulaimani, Iraq.
Hossein DinpanahEmergency Department, 9-Day Hospital, Torbat Heydariyeh University of Medical Sciences, Torbat Heydariyeh, Iran.
Mir Saeed YekaninejadDepartment of Epidemiology and Biostatistics School of Public Health, Tehran University of Medical Sciences, Poursina Ave, Tehran, Iran.
Alireza EsmaeiliDepartment of Emergency Medicine, Shahid Sadoughi University of Medical Sciences, Yazd, Iran.
Michael E JonesDivision of Genetics and Epidemiology, The Institute of Cancer Research, London, UK.
Shaghayegh Askarian-AmiriPhysiology Research Center, School of Medicine, Iran University of Medical Sciences, Hemmat Highway, Tehran, Iran.
Mahmoud YousefifardPhysiology Research Center, School of Medicine, Iran University of Medical Sciences, Hemmat Highway, Tehran, Iran. yousefifard.m@iums.ac.ir.
Mostafa HosseiniDepartment of Epidemiology and Biostatistics School of Public Health, Tehran University of Medical Sciences, Poursina Ave, Tehran, Iran. mhossein110@yahoo.com.ORCID http://orcid.org/0000-0002-1334-246X
Iran University of Medical Sciences · IRTabriz University of Medical Sciences · IRSulaimani Polytechnic University · IQInstitute of Cancer Research · GBIranshahr University · IRShahid Sadoughi University of Medical Sciences and Health Services · IRSina Hospital · IRTehran University of Medical Sciences · IRTorbat Heydarieh University of Medical Sciences · IRUniversity of Maragheh · IRUniversity of Sulaimani · IQ

Funding

Iran National Science Foundation 958774
6 · The paper itself

Abstract

purposeAlthough, Canadian C-spine rule and the National Emergency X-Radiography Utilization Study (NEXUS) criteria in ruling out clinically important cervical spine injuries have been validated using large prospective studies, no consensus exist as to which rule should be endorsed. Therefore, the aim of the present study was to compare the accuracy of the Canadian C-spine and NEXUS criteria in ruling out clinically important cervical spine injuries in trauma patients. Finally, we introduced the modified Canadian C-spine rule.

methodsA prospective diagnostic accuracy study was conducted on trauma patients referred to four emergency departments of Iran in 2018. Emergency physicians evaluated the patients based on the Canadian C-spine rule and NEXUS criteria in two groups of low risk and high risk for clinically important cervical spine injury. Afterward, all patients underwent cervical imaging. In addition, modified Canadian C-spine rule was derived by removing dangerous mechanism and simple rear-end motor vehicle collision from the model.

resultsData from 673 patients were included. The area under the curve of the NEXUS criteria, Canadian C-spine, and modified Canadian C-spine rule were 0.76 [95% confidence interval (CI) 0.71-0.81)], 0.78 (95% CI 0.74-0.83), and 0.79 (95% CI 0.74-0.83), respectively. The sensitivities of NEXUS criteria, Canadian C-spine, and modified Canadian C-spine rule were 93.4%, 100.0% and 100.0%, respectively.

conclusionsThe modified Canadian C-spine rule has fewer variables than the original Canadian C-spine rule and is entirely based on physical examination, which seems easier to use in emergency departments.

Indexed as

Clinical Decision RulesAdultAgedArea Under CurveCervical VertebraeChecklistDiagnosis, DifferentialFemaleHumansIranMagnetic Resonance ImagingMaleMiddle AgedProspective StudiesRadiographySpinal InjuriesCervical spineDecision supportive techniqueDiagnostic imagingSensitivity and specificityTrauma

Identifiers

PMID32965634
OpenAlexW3088744208

What OpenQuestion holds

Textmetadata
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.