Date of Award

Spring 5-22-2021

Document Type

Doctor of Nursing Practice Final Manuscript

Degree Name

Doctor of Nursing Practice



First Advisor

Pedro Alonso Colio DNP, FNP-C, ENP-C, CCRN, APRN



The aim of this evidence-based project was to implement the Canadian C-Spine Rule guideline for low-risk c-spine injury in a urban urgent care in order to reduce unnecessary imaging (cervical X-ray), radiation exposure, and to identify patients requiring ED referral for computed tomography (CT) scans. The use of imaging can help to identify life-threatening neck injuries when clinically appropriate; however, unnecessary imaging without the use of a clinical decision tool is associated with an annual cost of $6.8 million-$9.6 million in the United States. Encouraging providers to increase patient engagement and to use other valuable diagnostic tests is part of the solution to over imaging. The literature supports the use of validated clinical-decision guidelines to improve assessment, minimize costs, foster resource utilization, decrease the length of stay in waiting rooms, and reduce unnecessary radiation exposure. The findings suggested significant reduction in unnecessary imaging and identified patients needing ED referral for more advanced imaging. Future projects can focus on the utilization of other clinical guidelines for the management of low-risk patient populations.

Key words: Canadian C-Spine Rule, NEXUS C-Spine, neck injury, neck CT, clinical decision guidelines, clinical decision rules.

Included in

Nursing Commons