The aim of this study was to determine the inter-rater agreement between physicians and nurses regarding eligibility for application of the Canadian C-Spine Rule (CCR) and assessment of the criteria of the CCR.

In this observational study, nurses and physicians independently assessed the CCR criteria in a convenience sample of patients with potential C-spine injury. Data were entered onto separate data sheets. The outcomes of interest were the inter-rater agreement between nurse and physician regarding eligibility for application of the rule, for assessment of each component of the rule and for interpretation of the rule overall, assessed by kappa analysis.

In total, 88 cases were eligible for analysis. Physicians and nurses agreed on which patients were eligible for CCR application in 96.6% of cases. Inter-rater agreement for most CCR criteria was good (κ > 0.61), with the exception of midline tenderness (κ = 0.58) and range of motion, which most nurses did not test.

This study shows that nurses have the potential to reliably apply the Canadian C-Spine Rule but require further training in the assessment of midline tenderness and range of motion.