Standard x-rays usually are used to diagnose cervical spine fractures in patients who have suffered blunt trauma. However, three clinical factors—focal neurologic deficit, severe brain injury, and injuries caused by high-speed mechanisms (for example, high-speed motor vehicle accident or high fall)—can help doctors decide which blunt trauma patients aged 65 or older are at high risk for cervical spine fracture and thus need a computed tomography scan, according to a recent study.
These three factors, which are evident on initial emergency department evaluation, can guide appropriate imaging and lead to earlier diagnosis to prevent spinal cord injuries, explains lead investigator C. Craig Blackmore, M.D., M.P.H., of the Harborview Medical Center, University of Washington. The study was supported in part by the Agency for Healthcare Research and Quality (HS11291).
Dr. Blackmore and his colleagues used the inpatient trauma registry of a regional trauma center to identify 103 blunt trauma patients aged 65 and older with cervical spine fractures (case patients) from 1995 through 2002. They compared these patients with 107 randomly selected same-aged blunt trauma patients without cervical spine fracture (control patients) to identify clinical factors that could be used to stratify patients into fracture risk groups.
The prediction rule stratified patients into subgroups with fracture risks ranging from 0.4 percent to 24.2 percent. The three groups of older patients at highest risk for fracture included patients with neurologic deficit (24.2 percent), those with severe head injury (7.9 percent), and those with a high-energy mechanism of injury (3.4 percent).
Low-energy trauma (that is, a fall from standing or sitting) in the absence of a focal neurologic deficit or severe head injury was associated with the lowest risk of fracture (0.4 percent). The researchers note, however, that fractures caused by low-energy trauma occur more frequently in the elderly and may not include the clinical factors that are predictive of injury. Thus, a separate evaluation focusing on low-energy mechanisms of injury would be required to identify independent predictors for this group of patients.
See "Cervical spine fractures in patients 65 years and older: A clinical prediction rule for blunt trauma," by Lawrence D. Bub, M.D., Dr. Blackmore, Frederick A. Mann, M.D., and Friedrich M. Lomoschitz, M.D., in the January 2005 Radiology 234, pp. 143-149.
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