CCS rules

Question 1

Does the patient have any high risk factors that mandate radiography?

Answer 1

greater than 65 years old
Dangerous mechanism
Paresthesias in extremities

if Yes, obtain CT
If no look at the next step

Question 2

does the patient have any of the following low risk factors to allow safe assessment of range of motion?

Answer 2

Simple rear end motor vehicle accident
assumes sitting position in waiting room
Ambulatory at any time
Delayed onset of neck pain
Absence of midline, C-spine tenderness

If no , obtain CT
If yes, look at the next step

Question 3

Is the patient able to actively rotate the neck?

Answer 3

Rotate neck 45° to the left and right

If no obtain CT

If yes, no imaging needed

Question 4

dangerous mechanisms

Answer 4

Fall from greater than 1 m or five stairs

axial loading to head

High speed, MVA greater than 60 mph

Roll over ejection

Bicycle collision

Motorized, recreational vehicles

Question 5

non-simple mva

Answer 5

pushed into oncoming traffic

Hit by a bus or large truck

Roll over

Hit by high-speed vehicle