Validity of a decision rule to reduce cervical spine radiography in elderly patients with blunt trauma

Touger, Michael; Gennis, Paul; Nathanson, Noel; Lowery, Douglas W.; Pollack, Charles V.; Hoffman, Jerome R.; Mower, William R.

doi:10.1067/mem.2002.125708

Cited by 90 publications

(57 citation statements)

References 10 publications

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“…Not surprisingly, current diagnostic and management protocols advise more liberal use of CT, particularly in the elderly population [19,22,23].…”

Section: Why Does Geriatric Brain Injury Differ?mentioning

confidence: 99%

“…Rigidity of the cervical spine makes the occipitocervical junction more prone to injury; thereby, upper cervical (C) spine injuries relatively more frequently accompany gTBI than subaxial C-spine fractures [19,20]. Similarly reduced flexibility of the cranial-cranio-cervical structures as well as reduced turgor of the soft tissues around, including that of the cervical muscles, may account for the surprisingly high incidence of positive computed tomography (CT) findings, reaching to more than 10 % of minor head injuries in the elderly [21].…”

Section: Why Does Geriatric Brain Injury Differ?mentioning

confidence: 99%

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Geriatric Traumatic Brain Injury in Hungary and Eastern Europe

Büki

Czeiter

Kovács

et al. 2012

Curr Tran Geriatr Gerontol Rep

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While the incidence of traumatic brain injury (TBI) is decreasing in the young, active population, injuries are getting more frequent among the elderly; as the geriatric population is in a constant rise and the relative cost of care is particularly high in this group of patients, the economic burden of TBI does not decline. This review is aimed to identify predisposing factors and characteristic features of geriatric brain injury, primarily focusing on the comparison between Eastern and Western European countries. While economically each of these is a high-or middle-income country, the differences in mortality and morbidity, approaches, and policies applied by health care providers are substantial. On the basis of the disappointing outcome results in Eastern Europe, one may conclude that therapeutic guidelines defined on the basis of the "Western experience" should only be applied in conjunction with a systematic reorganization of health care in Eastern Europe.

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“…Not surprisingly, current diagnostic and management protocols advise more liberal use of CT, particularly in the elderly population [19,22,23].…”

Section: Why Does Geriatric Brain Injury Differ?mentioning

confidence: 99%

Section: Why Does Geriatric Brain Injury Differ?mentioning

confidence: 99%

Geriatric Traumatic Brain Injury in Hungary and Eastern Europe

Büki

Czeiter

Kovács

et al. 2012

Curr Tran Geriatr Gerontol Rep

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“…The LOE 5 National X-Radiography Utilization Study (NEXUS) identified midline cervical neck tenderness, focal neurological deficit, altered mental status, intoxication, and distracting injury as the 5 key clinical criteria predicting high risk for spine injury in adults, 61 children, 62 and the elderly 63 and demonstrated that elimination of any of these factors weakened the predictive value. 64 The LOE 5 Canadian C-Spine Rule (CCR) study 65 identified age Ն65 years, dangerous injury mechanism, and paresthesia as conditions that should create a high level of suspicion for cervical spine injury.…”

Section: Consensus On Sciencementioning

confidence: 99%

Part 13: First Aid

Markenson¹,

Ferguson²,

Chameides³

et al. 2010

Circulation

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The International First Aid Science Advisory Board identified 38 questions in first aid practice that had not been subjected to an evidence review process or that needed to be updated since the 2005 process. Two or more members of the International First Aid Science Advisory Board volunteered to independently review the scientific literature and complete an evidence-based review worksheet summarizing the literature (see Part 2 of this supplement for additional information). After the evidence was presented to the full board, a draft consensus summary of the scientific evidence and a draft consensus treatment recommendation were developed and represented at a subsequent meeting. Thus, each question, evidence-based review, draft summary of science, and draft treatment recommendation was presented and discussed on 2 separate occasions, and a Consensus on Science and Treatment Recommendation was reached by the Board. This document is a report of the group's consensus.As in 2005, the worksheets revealed the continuing paucity of scientific evidence to support specific first aid interventions. Very little research is being conducted in first aid, and most of the recommendations are extrapolations from research and experience in other medical venues, animal studies, and case series. It is hoped that this document will be a stimulus to future research in first aid. First Aid for Medical Emergencies SummaryThe medical questions addressed include poisoning, anaphylaxis, oxygen administration, and aspirin administration for a suspected coronary event.No changes were recommended for first aid management of acute poisoning.In reviewing epinephrine administration for anaphylaxis, evidence was found that laypeople and some medical and prehospital professionals are unable to recognize the signs and symptoms of anaphylaxis and therefore cannot, without training, make an independent decision to administer epinephrine with an auto-injector or to administer a second dose if the first is not effective. This issue takes on added importance in view of legislation in some jurisdictions that permits these actions.No evidence was found, except in decompression injuries, to support the routine administration of oxygen by first aid providers.The administration of aspirin to a victim experiencing chest discomfort is problematic. The literature is clear on the benefit of early administration of aspirin in an acute coronary event, except when there is a clear contraindication, such as aspirin allergy or a bleeding disorder. Less clear, however, is whether first aid providers can recognize the signs and symptoms of an acute Consensus on ScienceThere are no human studies on the effect of treating oral caustic exposure with dilution therapy. One in vitro LOE 5 chemistry study 2 demonstrated no benefit from the addition of large volumes of diluent to either a strong base or a strong acid. Five LOE 5 animal studies 3-7 demonstrated histological benefit to the esophagus when a diluent was administered following exposure to an alkali or acid. Treat...

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“…It has been reported than cervical fractures in the elderly are more likely to occur from falls, while cervical fractures in younger patients are more likely to occur from higher energy impact activities, such as high-speed motor vehicle accidents. 24 There also is a disproportionate increase in the prevalence of C2 fractures in the elderly, including an 8-fold increase in the prevalence of odontoid fractures in patients greater than 65 years of age compared to younger patients. 24 While the reason for the increase in odontoid fractures and the precise mechanism of odontoid fractures in the elderly is not known, it has been hypothesized that it may be due to several factors, including the pattern of mechanical stress placed on the cervical spine in falls commonly seen in the elderly population, the weakening effects of osteopenia on the narrow odontoid, and the pattern of progressive degenerative changes in the cervical spine.…”

Section: Discussion Fmentioning

confidence: 99%

“…24 While the reason for the increase in odontoid fractures and the precise mechanism of odontoid fractures in the elderly is not known, it has been hypothesized that it may be due to several factors, including the pattern of mechanical stress placed on the cervical spine in falls commonly seen in the elderly population, the weakening effects of osteopenia on the narrow odontoid, and the pattern of progressive degenerative changes in the cervical spine. 10,24 Nonetheless, it has been recommended that there should be concern for serious cervical spine injuries in any older patient who presents with a history of minor trauma or a fall, and that C2 in-…”

Section: Discussion Fmentioning

confidence: 99%