School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada; Department of Emergency Medicine, University of British Columbia, Vancouver, BC, Canada.
School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada; Department of Emergency Medicine, The University of Ottawa, Ottawa, Ontario, Canada.
Am J Emerg Med. 2023 May;67:144-155. doi: 10.1016/j.ajem.2023.02.008. Epub 2023 Feb 10.
Adults ≥ 65 are at risk of cervical spine (C-spine) injury, even after low-level falls. The objectives of this systematic review were to determine the prevalence of C-spine injury in this population and explore the association of unreliable clinical exam with C-spine injury.
We conducted this systematic review according to PRISMA guidelines. We searched MEDLINE, PubMed, EMBASE, Scopus, Web of Science, and the Cochrane Database of Systematic reviews to include studies reporting on C-spine injury in adults ≥ 65 years after low-level falls. Two reviewers independently screened articles, abstracted data, and assessed bias. Discrepancies were resolved by a third reviewer. A meta-analysis was performed to estimate overall prevalence and the pooled odds ratio for the association between C-spine injury and an unreliable clinical exam.
The search identified 2044citations, 138 full texts were screened, and 21 studies were included in the systematic review. C-spine injury prevalence in adults ≥ 65 years after low-level falls was 3.8% (95% CI: 2.8-5.3). The odds of c-spine injury in those with altered level of consciousness (aLOC) v/s not aLOC was 1.21 (0.90-1.63) and in those with GCS < 15 v/s GCS 15 was 1.62 (0.37-6.98). Studies were at a low-risk of bias, although some had low recruitment and significant loss to follow-up.
Adults ≥ 65 years are at risk of cervical spine injury after low-level falls. More research is needed to determine whether there is an association between cervical spine injury and GCS < 15 or altered level of consciousness.
即使是在轻度跌倒后，≥ 65 岁的成年人也存在颈椎（C 脊柱）损伤的风险。本系统综述的目的是确定该人群中 C 脊柱损伤的发生率，并探讨不可靠的临床检查与 C 脊柱损伤的关系。
我们根据 PRISMA 指南进行了这项系统综述。我们检索了 MEDLINE、PubMed、EMBASE、Scopus、Web of Science 和 Cochrane 系统评价数据库，以纳入报告≥ 65 岁成年人在轻度跌倒后 C 脊柱损伤的研究。两位评审员独立筛选文章、提取数据并评估偏倚。分歧由第三位评审员解决。我们进行了荟萃分析，以估计总体发生率和不可靠临床检查与 C 脊柱损伤之间的关联的合并优势比。
搜索共确定了 2044 篇文献，筛选了 138 篇全文，有 21 项研究纳入了系统综述。≥ 65 岁成年人在轻度跌倒后 C 脊柱损伤的发生率为 3.8%（95% CI：2.8-5.3）。意识水平改变（aLOC）与无 aLOC 相比，C 脊柱损伤的可能性为 1.21（0.90-1.63），GCS<15 与 GCS 15 相比为 1.62（0.37-6.98）。研究的偏倚风险较低，但有些研究的招募人数较低，随访失访率较高。
≥ 65 岁的成年人在轻度跌倒后存在颈椎损伤的风险。需要进一步研究以确定 C 脊柱损伤与 GCS<15 或意识水平改变之间是否存在关联。
