Execution:
- Exclude any high-risk factors:
- Age 65 or older
- Paresthesias in extremities
- Dangerous mechanism (Fall from >3 ft./5 stairs, axial load to the head (e.g. diving), MVA at high speed (>100km/h), rollover, ejection, motorized recreational vehicle, bicycle struck or collision
- Make sure all low-risk factors are present which allow AROM
- Simple rear-end collision
- Sitting in the emergency department
- Ambulatory at any time
- Delayed onset of neck pain
- No midline cervical spine tenderness
- AROM of the neck in rotation direction
- If any high-risk factors are present, not all low risk factors are present or patient is unable to rotate the neck > 45° –> Refer for x-rays!
| Study | Reliability | SN | Sp | LR+ | LR- |
| Michaleff et al. (2012) | NA | 90-100 | 1-77 | NA | NA |
| Comment: Unlikely to see these patients in primary care as these rules were designed to avoid unnecessary X-rays in the emergency department. | |||||
