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Cervical Spine Fractures in Elderly Patients with Hip Fracture After Low-Level Fall: An Opportunity to Refine Prehospital Spinal Immobilization Guidelines?

Published online by Cambridge University Press:  22 January 2014

Lori L. Boland ,
Paul A. Satterlee  and
Paul R. Jansen
Lori L. Boland*
Affiliation:
Allina Health Emergency Medical Services, St. Paul, Minnesota USA Division of Applied Research, Allina Health, Minneapolis, Minnesota USA
Paul A. Satterlee
Affiliation:
Allina Health Emergency Medical Services, St. Paul, Minnesota USA Department of Emergency Medicine, Abbott Northwestern Hospital, Minneapolis, Minnesota USA
Paul R. Jansen
Affiliation:
Minnesota Department of Health, St. Paul, Minnesota USA
*
Correspondence: Lori L. Boland, MPH Division of Applied Research Allina Health 2925 Chicago Avenue South Minneapolis, MN 55407 USA E-mail lori.boland@allina.com
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Abstract

Background

Conventional prehospital spine-assessment approaches based on low index of suspicion and mechanism of injury (MOI) result in the liberal application of spinal immobilization in trauma patients. A painful distracting injury (DI), such as a suspected hip fracture, historically has been a sufficient condition for immobilization, even in an elderly patient who suffers a simple fall from standing and exhibits no other risk factors for spinal injury. Because the elderly are at increased risk of hip fracture from low-level falls, and are also particularly susceptible to the discomfort and morbidity associated with immobilization, the prevalence of cervical spine (c-spine) fracture in this patient population was examined.

Methods

Hospital billing records were used to identify all cases of traumatic femur fracture in Minnesota (USA) in 2010-2011. Concurrent diagnosis and external cause codes were used to estimate the prevalence of c-spine fracture by age and MOI.

Results

Among 1,394 patients with femur fracture, 23 (1.7%) had a c-spine fracture. When the MOI was a fall from standing or sitting height and the patient age was ≥65, the prevalence dropped to 0.4% (2/565). The prevalence was similar when the definition of hip fracture additionally included pelvis fractures (0.5%; 11/2,441). Eight of the 11 patients with c-spine fracture had diagnosis codes indicative of criteria other than the DI that likely would have resulted in immobilization (eg, head injury and compromised mental status).

Conclusions

C-spine fracture is extremely rare in elderly patients who sustain hip fracture as a result of a low-level fall, and appears to be accompanied frequently by other known predictors of spinal injury besides DI. More research is needed to determine whether conservative use of spinal immobilization may be warranted in elderly patients with hip fracture after low-level falls when the only criteria for immobilization is the distracting hip injury.

BolandLL , SatterleePA , JansenPR . Cervical Spine Fractures in Elderly Patients with Hip Fracture After Low-Level Fall: An Opportunity to Refine Prehospital Spinal Immobilization Guidelines?Prehosp Disaster Med. 2014;29(1):1-4.

Keywords

cervical spine fracturedistracting injuryEmergency Medical Serviceship fracturespinal immobilization
Type
Brief Report
Information
Prehospital and Disaster Medicine , Volume 29 , Issue 1 , February 2014 , pp. 96 - 99
Copyright
Copyright © World Association for Disaster and Emergency Medicine 2014 

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References

1. Vickery, D. The use of the spinal board after the pre-hospital phase of trauma management. Emerg Med J. 2001;18(1):51-54.Google Scholar
2. Hoffman, JR, Mower, WR, Wolfson, AB, Todd, KH, Zucker, MI. National Emergency X-Radiography Utilization Study Group. Validity of a set of clinical criteria to rule out injury to the cervical spine in patients with blunt trauma. N Engl J Med. 2000;343(6):94-99.Google Scholar
3. Domeier, RM, Evans, RW, Swor, RA, Rivera-Rivera, EJ, Frederiksen, SM. Prehospital clinical findings associated with spinal injury. Prehosp Emerg Care. 1997;1(1):11-15.Google Scholar
4. Domeier, RM, Swor, RA, Evans, RW, et al. Multicenter prospective validation of prehospital clinical spinal clearance criteria. J Trauma. 2002;53(4):744-750.Google Scholar
5. Ullrich, A, Hendey, GW, Geiderman, J, Shaw, SG, Hoffman, J, Mower, WR, National Emergency X-Radiography Utilization Study (NEXUS) Group. Distracting painful injuries associated with cervical spinal injuries in blunt trauma patients. Acad Emerg Med. 2001;8(1):25-29.CrossRefGoogle Scholar
6. Stroh, G, Braude, D. Can an out-of-hospital cervical spine clearance protocol identify all patients with injuries? An argument for selective immobilization. Ann Emerg Med. 2001;37(6):609-615.Google Scholar
7. Domeier, RM, Frederiksen, SM, Welch, K. Prospective performance assessment of an out-of-hospital protocol for selective spine immobilization using clinical spine clearance criteria. Ann Emerg Med. 2005;46(2):123-131.Google Scholar
8. Burton, JH, Dunn, MG, Harmon, NR, Hermanson, TA, Bradshaw, JR. A statewide, prehospital emergency medical service selective patient spine immobilization protocol. J Trauma. 2006;61(1):161-167.Google Scholar
9. Rose, MK, Rosal, LM, Gonzalez, RP, et al. Clinical clearance of the cervical spine in patients with distracting injuries: It is time to dispel the myth. J Trauma Acute Care Surg. 2012;73(2):498-502.Google Scholar
10. World Health Organization. International Statistical Classification of Diseases and Related Health Problems, tenth revision, 2nd edition. Geneva: Switzerland; 2004.Google Scholar
11. Bub, LD, Blackmore, CC, Mann, FA, Lomoschitz, FM. Cervical spine fractures in patients 65 years and older: a clinical prediction rule for blunt trauma. Radiology. 2005;234(1):143-149.Google Scholar
12. Stiell, IG, Wells, GA, Vandemheen, KL, et al. The Canadian C-Spine Rule for radiography in alert and stable trauma patients. JAMA. 2001;286(15):1841-1848.CrossRefGoogle ScholarPubMed
13. Hauswald, M. A re-conceptualisation of acute spinal care. Emerg Med J. 2013;30(9):720-723.Google Scholar
14. Burton, JH, Harmon, NR, Dunn, MG, Bradshaw, JR. EMS provider findings and interventions with a statewide EMS spine-assessment protocol. Prehosp Emerg Care. 2005;9(3):303-309.Google Scholar
15. Ong, AW, Rodriguez, A, Kelly, R, Cortes, V, Protetch, J, Daffner, RH. Detection of cervical spine injuries in alert, asymptomatic geriatric blunt trauma patients: who benefits from radiologic imaging? Am Surg. 2006;72(9):773-776.Google Scholar
16. Kulvatunyou, N, Lees, JS, Bender, JB, Bright, B, Albrecht, R. Decreased use of cervical spine clearance in blunt trauma: the implication of the injury mechanism and distracting injury. Accid Anal Prev. 2010;42(4):1151-1155.CrossRefGoogle ScholarPubMed