School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada.
Department of Emergency Medicine, University of British Columbia, Vancouver, BC, Canada.
CJEM. 2024 Oct;26(10):721-726. doi: 10.1007/s43678-024-00752-x. Epub 2024 Sep 2.
The population is aging and falls are a common reason for emergency department visits. Appropriate imaging in this population is important. The objectives of this study were to estimate the prevalence of cervical spine injury and identify factors associated with cervical spine injuries in adults ≥ 65 years after low-level falls.
This was a pre-specified sub-study of a prospective observational cohort study of intracranial bleeding in emergency patients ≥ 65 years presenting after low-level falls. The primary outcome was cervical spine injury. The risk factors of interest were Glasgow coma scale (GCS) < 15, head injury, neck pain, age, and frailty defined as Clinical Frailty Scale ≥ 5. Multivariable logistic regression was used to measure the strength of association between risk factors and cervical spine injury. A descriptive analysis of absence of significant risk factors was performed to determine patients who may not require imaging.
There were 4308 adults ≥ 65 who sustained low-level falls with mean age of 82.0 (standard deviation ± 8.8) years and 1538 (35.7%) were male; 23 [0.5% (95% confidence interval (CI) 0.3-0.8%)] were diagnosed with cervical spine injuries. The adjusted odds ratios and 95% CIs were 1.3 (0.5-3.2) for GCS < 15, 5.3 (1.7-26.7) for head injury, 13.0 (5.7-31.2) for new neck pain, 1.4 (1.0-1.8) for 5-year increase in age, and 1.1 (0.4-2.9) for frailty. Head injury or neck pain identified all 23 cervical spine injuries. Management was a rigid collar in 19/23 (82.6%) patients and none had surgery.
In emergency patients ≥ 65 years presenting after a low-level fall, head injury, neck pain, and older age were associated with the diagnosis of cervical spine injury. There were no cervical spine injuries in those without head injury or neck pain. Patients with no head injury or neck pain may not require cervical spine imaging.
人口老龄化，跌倒成为急诊科就诊的常见原因。该人群的适当影像学检查非常重要。本研究的目的是评估 65 岁以上老年人因低水平跌倒后颈椎损伤的发生率，并确定与颈椎损伤相关的因素。
这是一项针对 65 岁以上因低水平跌倒致颅内出血的急诊患者前瞻性观察队列研究的预先指定亚研究。主要结局为颈椎损伤。感兴趣的危险因素为格拉斯哥昏迷评分（GCS）＜15、头部损伤、颈部疼痛、年龄和临床虚弱量表（Clinical Frailty Scale）≥5 定义的虚弱。多变量逻辑回归用于测量危险因素与颈椎损伤之间的关联强度。对无明显危险因素的患者进行描述性分析，以确定可能不需要影像学检查的患者。
4308 例 65 岁以上成年人因低水平跌倒，平均年龄为 82.0（标准差±8.8）岁，1538 例（35.7%）为男性；23 例（0.5%（95%置信区间（CI）0.3-0.8%））诊断为颈椎损伤。调整后的优势比和 95%CI 分别为 GCS＜15 为 1.3（0.5-3.2），头部损伤为 5.3（1.7-26.7），新颈部疼痛为 13.0（5.7-31.2），年龄每增加 5 年为 1.4（1.0-1.8），虚弱为 1.1（0.4-2.9）。头部损伤或颈部疼痛确定了所有 23 例颈椎损伤。23 例患者中，19 例（82.6%）采用硬性颈托固定，无手术治疗。
在因低水平跌倒后就诊的 65 岁以上急诊患者中，头部损伤、颈部疼痛和年龄较大与颈椎损伤的诊断相关。无头部损伤或颈部疼痛的患者无颈椎损伤。无头部损伤或颈部疼痛的患者可能不需要颈椎影像学检查。
