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Grandma Broke Her Neck? Prevalence of C-Spine Injuries from Ground Level Fall Over 65 Years

June 5, 2023

Written by Amanda Mathews

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This systematic review found that the prevalence of cervical spine injuries in patients 65 years or older after a ground level or low-level fall was between 3.8-4.1%.

Why does this matter?
Ground level falls in the elderly is one of the most common ED traumatic complaints and is associated with a high level of morbidity and mortality. Often, whether due to concomitant injuries or underlying medical conditions, the physical exam is suboptimal for evaluation of cervical spine injuries. This systematic review describes the prevalence of cervical spine injuries in patient 65 or older and assesses whether Glasgow Coma Score (GCS) is associated with these injuries.

They done fell out again
This systematic review included studies of patients 65+ who had a witnessed low-level fall or an unwitnessed fall of < 3 feet and had outcome data on cervical spine injuries reported. Twenty-one studies were included in the review, with a population of 17,192 patients. Of this patient population, 968 sustained cervical spine injuries. Using different models, they found the pooled prevalence of cervical spine injury to be 3.8-4.1%. An additional meta-analysis was performed to compare injuries in patients with GCS of 15 to those with GCS <15. The pooled odds ratio of cervical spine injury in adults with an altered level of consciousness (GCS <15) was 1.62 (95%CI 0.37 to 6.98, p=0.52) – meaning no association.

Ground level falls can be devastating to the geriatric population, and this study shows that cervical spine injuries are prevalent in this population. The authors were unable to draw any conclusions on GCS and cervical spine injuries. I will continue to be overly cautious in clearing an elderly patient’s collar without cervical spine CT imaging.

Editor’s note: The authors (which include Ian Steill of Canadian C-spine fame) call for a decision rule for patients ≥65 years. I’m not sure we need another decision rule. We already know not to stick our NEXUS out for older patients (i.e. don’t use NEXUS in older people). At some point, we just have to say – older patients with falls get a CT. This study affirms that statement. ~Clay Smith

Cervical spine injuries in adults ≥ 65 years after low-level falls – A systematic review and meta-analysis. Am J Emerg Med. 2023 May;67:144-155. doi: 10.1016/j.ajem.2023.02.008. Epub 2023 Feb 10.

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