Relationship of Mechanism of Injury to Asymptomatic Cervical Spine Fractures in the Elderly

The Canadian Cervical Spine Rule, a clinical decision-making tool for patients post-trauma is often interpreted as recommending cervical spine computed tomography in patients ≥ 65 years old, who sustain a dangerous mechanism of injury, and/or have extremity paresthesias. We retrospectively reviewed 6 years' of emergency department cervical spine computed tomography reports to determine fracture rates in patients ≥ 65, symptomatic or not, who did and did not have a dangerous mechanism. Of those ≥ 65 years old, 240/13925 (1.72%) patients had cervical spine fractures. The fracture rate in asymptomatic patients ≥ 65 was 0.27%. The fracture rate in asymptomatic patients ≥ 65, who did not have a dangerous mechanism of injury was 0.15%. The rate of unstable fractures requiring surgery was 0.007%. The findings suggest that the algorithm to scan asymptomatic patients ≥ 65, and/or those ≥ 65 without a dangerous injury mechanism, should be revisited for appropriateness and overall value.ABBREVIATIONS: CCR = The Canadian Cervical Spine Rule; CSCT = cervical spine computed tomography; ED = emergency department; EMR = electronic medical record; MVC = motor vehicle collision.