Asymptomatic cervical spine fractures: Current guidelines can fail older patients.

Background: Older adults represent a growing proportion of trauma patients treated in the United States, and cervical spine (c-spine) fracture is an injury that is increasingly common in this population. Neck pain is a major component of current clinical clearance guidelines, but some older adults with c-spine fractures report no neck pain after injury. The objective of this study was to investigate the frequency at which c-spine fractures were unassociated with neck pain in an aging population. Methods: A retrospective review was performed for patients aged 55 years or older with a c-spine fracture during a 4-year study period. All patients were GCS=15 and were considered asymptomatic if they did not complain of neck pain on initial presentation, denied tenderness to palpation of the c-spine on exam, and were without neurologic deficit. Differences between groups were assessed with Kruskal-Wallis and chi-square tests. Results: Of 173 patients with c-spine fractures, 36 (21%) were asymptomatic and reported no neck pain on presentation or on exam. The group without neck pain had higher median injury severity scores (15 vs 10, p<.001 were more likely to have another injured body region vs p=".004)," and had longer hospitalization days than patients with neck pain. twenty-two percent of the symptomatic group asymptomatic required halo fusion or other surgical intervention. discussion: study results indicate that one-fifth a c-spine fracture reported no pain on initial presentation denied tenderness palpation exam. presence absence may be an unreliable indicator in aging population. when used conjunction existing clearance guidelines denial lead missed injury. we recommend liberal imaging for older trauma significant mechanism trauma. level evidence: epidemiological iii lippincott williams wilkins inc.>

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