University of California, Davis School of Medicine, Department of Emergency Medicine, Sacramento, California.
West J Emerg Med. 2021 Sep 2;22(5):1190-1195. doi: 10.5811/westjem.2021.5.51844.
In this study we aimed to determine the rate of traumatic abnormalities on cervical spine magnetic resonance imaging (MRI) after a normal cervical spine computed tomography (CT) in older patients with ground-level falls. We hypothesized that MRI is low yield following a normal physical examination and normal CT after a ground-level fall.
This was a retrospective cohort study of patients 65 years and older evaluated with a cervical spine MRI following a ground-level fall. Inclusion criteria included age 65 years and older, ground-level fall, normal cervical spine CT followed by a cervical spine MRI. We abstracted data following accepted methodologic guidelines. Patients with any focal neurological finding were considered to have an abnormal neurological examination. Imaging studies were considered to be abnormal if there was a report of an acute traumatic injury. The primary outcome was a traumatic abnormality identified on MRI. We described data with simple descriptive statistics.
Eighty-seven patients with a median age of 74 (interquartile range [IQR] 69, 83]) years had an MRI following a normal cervical spine CT. Median emergency department length of stay was 8.2 hours (IQR 5.3, 13.5). Sixty-four (73.6%) patients had a normal neurological examination on arrival; eight of these patients (12.5% (95% confidence interval [CI], 5.6-23.2%) had an abnormal cervical spine MRI. Twenty-three patients (26.4%) had an abnormal neurological examination on arrival; two of these patients (8.7%, 95% CI, 1.1-28%) had an abnormal cervical spine MRI. Overall, 10 patients (11.5%) had an abnormal cervical spine MRI. One patient underwent operative intervention due to an unstable injury. Of the remaining nine patients with acute findings on cervical spine MRI, there were no other unstable injuries; two patients were managed with cervical orthosis, and seven patients had no additional management.
In this study of older patients with ground-level falls and normal, atraumatic, cervical spine CT, a small portion had traumatic abnormalities on MRI, with few requiring further intervention. Further study is required to identify criteria to determine when MRI should be performed in older patients after a ground-level fall.
本研究旨在确定在老年患者平地跌倒后行颈椎 CT 检查正常的情况下，颈椎磁共振成像（MRI）显示外伤性异常的发生率。我们假设在经过正常的体格检查和颈椎 CT 检查后，MRI 的结果并不理想。
这是一项回顾性队列研究，纳入了在平地跌倒后接受颈椎 MRI 检查的年龄在 65 岁及以上的患者。纳入标准包括年龄 65 岁及以上，平地跌倒，颈椎 CT 正常，随后进行颈椎 MRI。我们按照公认的方法学准则提取数据。有任何局灶性神经功能障碍表现的患者被认为存在异常神经检查。如果 MRI 报告有急性外伤性损伤，则认为影像学检查异常。主要结局是 MRI 发现外伤性异常。我们使用简单的描述性统计方法描述数据。
87 例患者的中位年龄为 74 岁（四分位距 [IQR] 69 岁，83 岁），在接受颈椎 CT 正常后进行了 MRI 检查。急诊停留中位数为 8.2 小时（IQR 5.3 小时，13.5 小时）。64 例（73.6%）患者在到达时神经检查正常；其中 8 例（12.5%（95%置信区间 [CI]，5.6-23.2%））MRI 显示颈椎异常。23 例（26.4%）患者在到达时神经检查异常；其中 2 例（8.7%，95% CI，1.1-28%）MRI 显示颈椎异常。总的来说，10 例（11.5%）患者的颈椎 MRI 异常。1 例因不稳定损伤接受了手术干预。在其余 9 例 MRI 显示急性发现的患者中，没有其他不稳定损伤；2 例患者使用颈椎矫形器治疗，7 例患者未进行其他治疗。
在这项研究中，我们对老年平地跌倒患者进行了颈椎 CT 检查，结果正常且无创伤性，一小部分患者在 MRI 上显示外伤性异常，其中很少需要进一步干预。需要进一步研究以确定在老年患者平地跌倒后何时应进行 MRI 检查的标准。
