According to Canadian C-spine rule, which of the following patients can safely have cervical spine imaging deferred without further evaluation?
- A A 70-year-old who fell down stairs with neck pain but normal vital signs
- B A 40-year-old with dangerous mechanism and paresthesia in both arms
- C A 25-year-old ambulatory at scene with isolated neck pain, no midline tenderness, able to rotate neck 45 degrees left and right ✓
- D A 33-year-old with GCS 14 and midline cervical tenderness
Correct answer: C. A 25-year-old ambulatory at scene with isolated neck pain, no midline tenderness, able to rotate neck 45 degrees left and right
Explanation
The Canadian B-spine rule clears the cervical spine clinically if there is no high-risk factor (age over 65, dangerous mechanism, limb paresthesia), no low-risk factor mandating imaging (midline tenderness, inability to rotate 45 degrees, delayed onset, extremity numbness), and the patient can actively rotate the neck 45 degrees each way. Option C satisfies all three steps, so imaging can be deferred.
Reference: Tintinalli's Emergency Medicine: A Comprehensive Study Guide, 9th ed.
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Written and medically reviewed by the StethoPrep medical team.