Can emergency nurses use the Canadian cervical spine rule to reduce unnecessary patient immobilisation? Phil Miller BA Hons RGN (Nurse Researcher) * , Frank Coffey MMedSci MRCPI FRCSEd FCEM (Consultant Emergency Department), Anne-Marie Reid BSc RGN (Nurse Research/Study Coordinator), Keith Stevenson PhD MAPsych MAEd Cert Ed (Deputy Director of Postgraduate Nursing Research Education) University Hospital Nottingham, Derby Road, Nottingham NG7 2UH, United Kingdom Received 19 November 2005; received in revised form 31 January 2006; accepted 5 March 2006 Summary The Canadian c-spine rule (CCR) allows safe, reproducible use of radiog- raphy in alert, stable patients with potential c-spine injury in the emergency setting [Stiell, I., Clement, C., McKnight, R., Brison, R., Schull, M., Lowe, B., Worthington, J., Eisenhauer, M., Cass, D., Greenberg, G., MacPhail, I., Dreyer, J., Lee, J., Bandi- era, G., Reardon, M., Holroyd, B., Lesiuk, H., G. Wells, 2003. The Canadian c-spine rule versus the nexus low-risk criteria in patients with trauma. The New England journal of medicine 349 (26), 2510–2518; Stiell, I., Wells, G., Vandemheen, K., Clement, C., 2001. The Canadian c-spine rule for radiography in alert and stable trauma patients. JAMA 286 (15), 1841]. This paper reports on a study of emergency nurses’ ability to identify patients requiring immobilisation using the CCR. Emergency department triage nurses (N = 112) were trained in the use of the CCR and then asked to use the tool over the following 14 months in the assessment of 460 patients who presented with potential c-spine injury. Trained medical staff repeated 55% of the clinical assessments independently using the rule. The level of agreement between nurse and medical judgement was calculated. The inter- rater reliability using the j statistic was 0.6 (95% CI 0.50–0.62 N = 254) indicating a ‘good’ level of agreement. The majority of nurses indicated they were comfort- able using the rule. KEYWORDS Cervical spine injury; Triage; Practice guideline; Immobilisation 0965-2302/$ - see front matter  c 2006 Elsevier Ltd. All rights reserved. doi:10.1016/j.aaen.2006.03.003 * Corresponding author. Tel.: +44 115 9249924x37070. E-mail address: philip.miller@qmc.nhs.uk (P. Miller). Accident and Emergency Nursing (2006) 14, 133–140 www.elsevierhealth.com/journals/aaen Accident and Emergency Nursing