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February 6, 2002

Decisions About Cervical Spine Radiography Following Trauma

Author Affiliations

Stephen J.LurieMD, PhD, Senior EditorIndividualAuthor

JAMA. 2002;287(5):583-584. doi:10.1001/jama.287.5.583

To the Editor: Dr Stiell and colleagues1 developed the Canadian C-Spine Rule to reduce the use of unnecessary C-spine radiography in alert, stable patients who might have a C-spine injury. However, 3 limitations of the study will limit application of the rule. First, the authors repeatedly cite a "dangerous mechanism of injury" as one of the criteria of patients at "high risk" for C-spine injury, yet do not define "dangerous mechanisms." The lack of definition makes this criterion open to wide interpretation. Similarly, the authors state that "our data clearly demonstrate that particular mechanisms of injury are associated with substantially increased risk of important injury," but fail to identify these mechanisms.

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