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Purpose. The Canadian C-Spine Rule (CCR) was recently derived (2001) and validated (2003) and shown to be highly sensitive for c-spine injury. Other clinical decision rules from our group (e.g. Ottawa Ankle Rules) are reportedly used by over 90% of Canadian emergency physicians. Compared to these, the CCR is newer, more complicated, and involves a higher stakes decision. We conducted a survey to determine current use of and attitudes towards this new rule.
Methods. We surveyed members of the Canadian Association of Emergency Physicians about their use of the CCR. Conducted between March and May 2003, the 4-page survey included 24 largely closed-ended questions and 3 sections: one on attitudes towards and use of the CCR, one on use of other clinical decision rules, and a final section on practice details and demographics. The sample frame included 400 active CAEP members, and excluded those listed as non-MD's, retired, or not currently residing in Canada. The survey was conducted according to standard survey methodology (Dillman, 2000).
Results. Of our initial sample of 400 names, 376 were eligible potential respondents with correct addresses. Overall response rate was 261/376, or 69.4%. 216 (82.8%) reported already being familiar with the rule, while 163 (62.5%) reported already using it. Of the 98 (37.5%) who did not currently use the rule, most (73.5%) indicated they would consider using the rule in the future. 4.6 % indicated they thought the rule was too complicated to use. Respondents' attitudes towards the CCR, as indicated by strong or moderate agreement on a 6-point scale: Useful in my practice 87.4%, Not unsafe 85.6%, Efficient use of time, 82.5%, Easy to use 76.1%, Would not increase lawsuits 75.3%, Easy to learn 74.6%, Easy to remember 60.4%. Factors associated with never having seen the rule include older age F(2,218) = 4.84, p = .009 , non-specialist status χ2(2)= 5.78, p = 0.055, part time status χ2(4)= 16.48, p = 0.002, and community hospital setting χ2(4)= 8.89, p = 0.06.
Conclusions. A surprising number of Canadian emergency physicians report being aware of and using the CCR. Attitudes towards the rule were generally high; memorability was rated lowest. Widespread use of this relatively new, more complicated, higher stakes clinical decision rule appears to be a reasonable goal.
See more of Poster Session - Clinical Strategies; Judgment and Decison Making
See more of The 26th Annual Meeting of the Society for Medical Decision Making (October 17-20, 2004)