Tafazolimoghadam Armin, Radmard Mahla, Zinzuwadia Shuchi, Amoah Akua Afrah, Chanmugam Arjun, Yousem David M
Tehran University of Medical Sciences, Tehran, Iran.
Johns Hopkins Medical Institution, Baltimore, USA.
Emerg Radiol. 2024 Dec;31(6):881-886. doi: 10.1007/s10140-024-02291-5. Epub 2024 Oct 30.
The Canadian Cervical Spine Rule (CCR) was based on patient data from 25 years ago and recommended cervical spine computed tomography (CSCT) for trauma patients aged 65 and older. We sought to determine the differences in rate of symptomatic and asymptomatic fractures of trauma patients ≥ 65 and < 65 years old, given the changing demographics and heterogeneity in today's elderly population.
This retrospective study of CSCT results from two hospitals in our health system included 5 years of trauma patient data. In addition to the primary variable of fracture rates, we separated the patients into symptomatic / asymptomatic groups and ≥ 65 and < 65 years of age.
In the ≥ 65 age group, 190 fractures among 9455 CSCTs (2.0%) were identified (112 females = 58.9%); 29 (0.3%) were in asymptomatic patients. In patients < 65, there were 199 (1.6%) fractures out of 12,531 CSCTs of which 19 (0.15%) were asymptomatic and 46 were female (23.1%). The rates of fractures in the older cohort (2.0%) were substantially different than those reported in the original CCR articles (5.2% and 6.6%). However, the fracture rates reported for those < 65 (1.4% and 1.7% historically) were similar to the current findings (1.6%).
The cervical spine fracture rate at our institution for patients ≥ 65, at 2.0%, was higher than those patients < 65 (1.6%) and favored female (58.9-23.1%) patients. The findings were much lower than those CCR percentages that led to scanning trauma patients who are 65 and older. Asymptomatic fractures are rarer still (0.15-0.30%).
加拿大颈椎规则（CCR）基于25年前的患者数据，建议对65岁及以上的创伤患者进行颈椎计算机断层扫描（CSCT）。鉴于当今老年人群的人口结构变化和异质性，我们试图确定年龄≥65岁和＜65岁的创伤患者有症状和无症状骨折发生率的差异。
这项对我们医疗系统中两家医院CSCT结果的回顾性研究纳入了5年的创伤患者数据。除了骨折发生率这一主要变量外，我们还将患者分为有症状/无症状组以及年龄≥65岁和＜65岁组。
在年龄≥65岁组中，9455次CSCT检查中发现了190例骨折（2.0%）（112例女性，占58.9%）；29例（0.3%）为无症状患者。在年龄＜65岁的患者中，12531次CSCT检查中有199例（1.6%）骨折，其中19例（0.15%）为无症状骨折，46例为女性（23.1%）。老年队列中的骨折发生率（2.0%）与CCR原始文章中报道的发生率（5.2%和6.6%）有很大差异。然而，年龄＜65岁患者的骨折发生率（历史上为1.4%和1.7%）与当前研究结果（1.6%）相似。
我们机构中年龄≥65岁患者的颈椎骨折发生率为2.0%，高于年龄＜65岁的患者（1.6%），且女性患者居多（58.9%-23.1%）。这些结果远低于导致对65岁及以上创伤患者进行扫描的CCR百分比。无症状骨折更为罕见（0.15%-0.30%）。
