Radmard Mahla, Tafazolimoghadam Armin, Hoseinyazdi Meisam, Shahriari Mona, Azadi Javad R, Chanmugam Arjun, Yousem David M
Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins Medical Institution, Baltimore, Maryland, USA.
Department of Radiology, Tehran University of Medical Sciences, Tehran, Iran.
Acad Emerg Med. 2025 Apr;32(4):396-402. doi: 10.1111/acem.14976. Epub 2024 Jun 28.
Cervical spine computed tomography (CSCT) scans are frequently performed in older emergency department (ED) trauma patients based on the 65-year-old high-risk criterion of the Canadian Cervical Spine Rule (CCR). We sought to determine the positivity rate of CSCT scans in symptomatic and asymptomatic patients to assess the current applicability of age in the CCR.
We reviewed CSCT ED reports from two institutional hospitals from 2018 to 2023. The primary variable was age; however, we also recorded fracture types and sites and type of treatments. Patients were separated into symptomatic and asymptomatic cohorts. We used a Fisher's exact test to compare variables between the asymptomatic and symptomatic groups and chi-square tests for comparison between age groups.
Of 9455 CSCTs performed in patients ≥ 65 years, 192 (2.0%) fractures were identified (113 females); 28 (0.30%) were in asymptomatic patients. The rates of fractures (1.6%) and asymptomatic fractures (0.18%) were lowest in the 65- to 70-year age group. There were no distinguishing features as to the level or part of the vertebra fractured or surgical treatment rate between asymptomatic and symptomatic patients.
Cervical spine fractures in posttrauma patients ≥ 65 years are uncommon, with the lowest incidence in those 65 to 70 years old. Excluding asymptomatic individuals aged 65-70 from routine CSCT presents a minimal risk of missed fractures (0.18%). This prompts consideration for refining age-based screening and integrating shared decision making into the clinical protocol for this demographic, reflecting the low incidence of fractures and the changing health profile of the aging population.
基于加拿大颈椎规则（CCR）的65岁高危标准，老年急诊科（ED）创伤患者经常进行颈椎计算机断层扫描（CSCT）。我们试图确定有症状和无症状患者CSCT扫描的阳性率，以评估CCR中年龄标准目前的适用性。
我们回顾了2018年至2023年两家机构医院的急诊CSCT报告。主要变量是年龄；然而，我们也记录了骨折类型、部位和治疗方式。患者被分为有症状和无症状两组。我们使用Fisher精确检验比较无症状组和有症状组之间的变量，并使用卡方检验比较年龄组之间的变量。
在≥65岁患者中进行的9455次CSCT检查中，发现192例（2.0%）骨折（113例为女性）；28例（0.30%）发生在无症状患者中。骨折率（1.6%）和无症状骨折率（0.18%）在65至70岁年龄组中最低。无症状和有症状患者在骨折椎体的水平或部位以及手术治疗率方面没有明显差异。
≥65岁创伤后患者的颈椎骨折并不常见，65至70岁患者的发病率最低。将65至70岁无症状个体排除在常规CSCT检查之外，漏诊骨折的风险极小（0.18%）。这促使我们考虑完善基于年龄的筛查，并将共同决策纳入该人群的临床方案，这反映了骨折的低发病率和老年人群健康状况的变化。
