implementation of the canadian cspine rule reduces cervical spine xray rate for alert patients with potential neck injury the objectives of this beforeandafter study of alert stable adult patients presenting to the emergency department of western hospital with potential neck injuries who were immobilized in hard cervical collars were to determine the impact of implementation of the canadian cspine rule on xray ordering rates and whether implementation of the rule reduced time in hard collars for patients with potential neck injury data collected included demographics mechanism of injury xray rate and time in hard collar data analysis was by chisquare test for proportions and mannwhitney u test for continuous variables there were 211 patients studied the xray ordering rate decreased from 67 to 50 25 relative reduction p 00187 time in hard collar was also reduced from a median of 128 min to a median of 103 min effect size 255 min but this did not reach statistical significance implementation of the canadian cspine rule reduced xray ordering by 25