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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 [email protected]
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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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