Download PDFPDF
Prevalence of midline cervical spine tenderness in the non-trauma population
Compose Response

Plain text

  • No HTML tags allowed.
  • Web page addresses and e-mail addresses turn into links automatically.
  • Lines and paragraphs break automatically.
Author Information
First or given name, e.g. 'Peter'.
Your last, or family, name, e.g. 'MacMoody'.
Your email address, e.g.
Your role and/or occupation, e.g. 'Orthopedic Surgeon'.
Your organization or institution (if applicable), e.g. 'Royal Free Hospital'.
Statement of Competing Interests


  • A rapid response is a moderated but not peer reviewed online response to a published article in a BMJ journal; it will not receive a DOI and will not be indexed unless it is also republished as a Letter, Correspondence or as other content. Find out more about rapid responses.
  • We intend to post all responses which are approved by the Editor, within 14 days (BMJ Journals) or 24 hours (The BMJ), however timeframes cannot be guaranteed. Responses must comply with our requirements and should contribute substantially to the topic, but it is at our absolute discretion whether we publish a response, and we reserve the right to edit or remove responses before and after publication and also republish some or all in other BMJ publications, including third party local editions in other countries and languages
  • Our requirements are stated in our rapid response terms and conditions and must be read. These include ensuring that: i) you do not include any illustrative content including tables and graphs, ii) you do not include any information that includes specifics about any patients,iii) you do not include any original data, unless it has already been published in a peer reviewed journal and you have included a reference, iv) your response is lawful, not defamatory, original and accurate, v) you declare any competing interests, vi) you understand that your name and other personal details set out in our rapid response terms and conditions will be published with any responses we publish and vii) you understand that once a response is published, we may continue to publish your response and/or edit or remove it in the future.
  • By submitting this rapid response you are agreeing to our terms and conditions for rapid responses and understand that your personal data will be processed in accordance with those terms and our privacy notice.
This question is for testing whether or not you are a human visitor and to prevent automated spam submissions.

Vertical Tabs

Other responses

Jump to comment:

  • Published on:
    Clarifying the Canadian C-Spine Rule
    • Ian G Stiell, Emergency Physiciand and Researcher University of Ottawa

    We thank Dr. Delaney and colleagues for their valuable research into the concept of midline cervical tenderness. Unlike the NEXUS critiera, the Canadian C-Spine Rule does not use midline tenderness as a positive indication for imaging. Our original study in JAMA 2001 found that assessment of this criterion amongst alert trauma patients at risk of c-spine tenderness had excellent interobserver agreement between ED physicians with a kappa of 0.78. We found that absence of midline tenderness was a good negative predictor of c-spine injury but that presence of of such tenderness was non-specific and not useful. Hence, absence of midline tenderness is considered a low-risk factor. Our NEJM 2003 validation study found that the CCR had both better sensitivity and specificity than NEXUS.
    Best regards
    1. Stiell IG, Wells GA, Vandemheen K, Clement C, Lesiuk H, De Maio VJ et al. The Canadian Cervical Spine Radiography Rule for alert and stable trauma patients. JAMA 2001; 286(15):1841-1848.
    2. Stiell IG, Clement C, McKnight RD, Brison R, Schull MJ, Rowe BH et al. The Canadian C-spine Rule versus the NEXUS low-risk criteria in patients with trauma. N Engl J Med 2003; 349:2510-2518.

    Conflict of Interest:
    developer of the Canadian C-Spine Rule