Consistent evidence was found to support the use of ' red flags ' to screen for serious pathologies , judicious use of imaging through clinical decision rule application and promotion of functional exercise coupled with advice and reassurance .
Neck pain and whiplash injuries are a common presentation to the ED , and a frequent cause of disability globally .
This rapid review investigated best practice for the assessment and management of musculoskeletal neck pain in the ED .
Multicentre prospective validation of use of the Canadian C-Spine Rule by triage nurses in the emergency department
Objectives : The Canadian C-Spine Rule for imaging of the cervical spine was developed for use by physicians . We believe that nurses in the emergency department could use this rule to clinical ly clear the cervical spine . We prospect ively evaluated the accuracy , reliability and acceptability of the Canadian C-Spine Rule when used by nurses . Methods : We conducted this three-year prospect i ve cohort study in six Canadian emergency departments . The study involved adult trauma patients who were alert and whose condition was stable . We provided two hours of training to 191 triage nurses . The nurses then assessed patients using the Canadian C-Spine Rule , including determination of neck tenderness and range of motion , reapplied immobilization and completed a data form . Results : Of the 3633 study patients , 42 ( 1.2 % ) had clinical ly important injuries of the cervical spine . The kappa value for interobserver assessment s of 498 patients with the  Canadian C-Spine Rule  was 0.78 . We calculated sensitivity of 100.0 % ( 95 % confidence interval [ CI ] 91.0%–100.0 % ) and specificity of 43.4 % ( 95 % CI 42.0%–45.0 % ) for the Canadian C-Spine Rule as interpreted by the investigators . The nurses classified patients with a sensitivity of 90.2 % ( 95 % CI 76.0%–95.0 % ) and a specificity of 43.9 % ( 95 % CI 42.0%–46.0 % ) . Early in the study , nurses failed to identify four cases of injury , despite the presence of clear high-risk factors . None of these patients suffered sequelae , and after retraining there were no further missed cases . We estimated that for 40.7 % of patients , the cervical spine could be cleared clinical ly by nurses . Nurses reported discomfort in applying the Canadian C-Spine Rule in only 4.8 % of cases . Conclusion : Use of the Canadian C-Spine Rule by nurses was accurate , reliable and clinical ly acceptable . Widespread implementation by nurses throughout Canada and elsewhere would diminish patient discomfort and improve patient flow in overcrowded emergency departments
Consistent evidence was found to support the use of ' red flags ' to screen for serious pathologies , judicious use of imaging through clinical decision rule application and promotion of functional exercise coupled with advice and reassurance .
Neck pain and whiplash injuries are a common presentation to the ED , and a frequent cause of disability globally .
This rapid review investigated best practice for the assessment and management of musculoskeletal neck pain in the ED .