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Certain clinical criteria can identify elderly trauma victims who don't need an x-ray to rule out cervical spine injury

Elderly patients who suffer even mild trauma, usually from a fall, have a greater risk of cervical spine injuries than younger trauma victims, probably because of age-related problems such as osteopenia (reduced spinal bone mass). Often, it is difficult to tell which trauma patients need x-rays to rule out cervical spine injuries. However, a new study outlines specific clinical factors that identify elderly patients at low risk of having cervical spine injury who do not need x-rays. This approach correctly identified all of the very old (older than 80 years) cervical spine injury victims as well as those who did not have such injuries.

Essentially, the researchers found that x-rays were not needed for elderly blunt trauma victims who did not have any of the following: posterior midline cervical spine tenderness, focal neurological deficit, abnormal level of alertness, evidence of intoxication, or clinically apparent distracting painful injury. This approach was confirmed as useful for identifying younger cervical spine injury patients in the recently completed National Emergency X-radiography Utilization Study (NEXUS), according to William R. Mower, M.D., Ph.D. In the current study, which was supported by the Agency for Healthcare Research and Quality (HS08239), Dr. Mower and his colleagues at the University of California, Los Angeles' Emergency Medicine Center analyzed use of this decision rule to identify and rule out cervical spine injuries among the 1,070 elderly NEXUS blunt trauma patients seen in the emergency departments of 21 participating U.S. medical centers.

The researchers also compared the elderly patients' injuries with those of younger patients enrolled in the NEXUS study. Nearly 5 percent of very elderly patients sustained cervical spine injuries compared with 2.4 percent of all NEXUS patients. Injuries to the craniocervical junction accounted for 47 percent of the injuries in the elderly but only 29 percent of injuries in younger patients. Older fracture victims were also likely to have more injuries than their younger counterparts (2.54 vs. 1.78 injuries/patient).

More details are in "Cervical spine injury in the very elderly," by Bryan Ngo, B.S., Jerome R. Hoffman, M.D., and Dr. Mower, in Emergency Radiology 7, pp. 287-291, 2000.

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