Stephen J.LurieMD, PhD, Senior EditorIndividualAuthor
To the Editor: Dr Stiell and colleagues1 attempted to formulate a clinical decision rule
(the Canadian C-Spine Rule) for detecting acute cervical spine (C-spine) injury
in alert patients following trauma.
I have a number of concerns about their study. First, there was no explanation
for the failure to enroll 25.7% (3281) of eligible patients. Second, the authors
do not indicate whether or not they attempted to trace the 4.5% (577) of patients
who could not be contacted by telephone. It is possible that these patients
may have later presented to other hospitals. Similarly, the coroner's office
could have been contacted to identify if any patient died as a result of being
discharged with a significant C-spine injury. Third, the authors did not consider
the possibility of painful distracting injuries, or alcohol or drug intoxication.
Lynch R. Decisions About Cervical Spine Radiography Following Trauma. JAMA. 2002;287(5):583-584. doi:10.1001/jama.287.5.583