• Am J Emerg Med · Mar 2022

    Utility of bedside assessment to evaluate for cervical-spine fracture post ground-level fall for patients 65 years and older.

    • Jeremy R Williams, Aaron J Muesch, James E Svenson, Alexander W Clegg, Brian W Patterson, and Michael A Ward.
    • Department of Emergency Medicine, University of Wisconsin-Madison, 800 University Dr. Suite 310, Madison, WI 53705, United States of America. Electronic address: jrwilliams9@wisc.edu.
    • Am J Emerg Med. 2022 Mar 1; 53: 208-214.

    ObjectivesThe effectiveness of current assessment tools for cervical fracture are mixed with respect to elderly patients. We aim to examine utility of history and physical exam to assess for cervical fracture for elderly patients suffering a ground-level fall.MethodsRetrospective cohort from a tertiary-care ED for patients ≥65 years, including dementia, after ground-level fall. Logistic regression was used to examine predictability of various clinical factors. Neurologic deficits were considered a hard sign for imaging and were not assessed.ResultsOf 1035 patient encounters analyzed, 683 had CT cervical-spine (C-spine) imaging (66.0%) and 16 (1.5%) had cervical fracture. C-spine tenderness (OR 4.7, 95% CI 1.5-14.1), neck pain (OR 10.5, 95% CI 3.4-32.5), altered mental status (AMS) (OR 5.1, 95% CI 1.7-15.6), and external trauma above the clavicles (ETC) (OR 3.8, 95% CI 1.2-12.3) predicted cervical fracture. C-spine tenderness and neck pain were collinear and run-in separate models. Dementia (OR 0.2, 95% CI 0.4-0.9) did not predict cervical fracture in this population. A combination of ETC, C-spine tenderness, and AMS had a sensitivity = 100% and specificity = 40.0% for detection of cervical fracture. ETC was found in all but two fractures requiring intervention with negative predictive value = 99.3%.ConclusionsClinical assessment for elderly patients without neurologic signs, together with the absence of ETC, cervical tenderness, and AMS may be reliable in ruling out cervical fracture after a ground-level fall, including patients with history of dementia. Fractures requiring intervention were rare in patients without ETC. However, findings are retrospective and prospective validation is required.Copyright © 2022 Elsevier Inc. All rights reserved.

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