The Canadian c-spine rule (CCR) allows safe, reproducible use of radiography 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., Bandiera, 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 
kappa 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 comfortable using the 
rule. The results suggest that UK emergency department nurses were able to use 
the Canadian c-spine rule to successfully guide selective immobilisation. A 25% 
reduction in immobilisation rates would have been achieved if the rule had been 
followed. Further studies are needed to test the reduction in levels of 
immobilisation that could be achieved in clinical practice.