Cervical spine injuries in adults ≥ 65 years after low-level falls - A systematic review and meta-analysis

Jessica McCallum; Debra Eagles; Yongdong Ouyang; Jamie Vander Ende; Christian Vaillancourt; Christophe Fehlmann; Risa Shorr; Monica Taljaard; Ian Stiell

doi:10.1016/j.ajem.2023.02.008

Cervical spine injuries in adults ≥ 65 years after low-level falls - A systematic review and meta-analysis

Am J Emerg Med. 2023 May:67:144-155. doi: 10.1016/j.ajem.2023.02.008. Epub 2023 Feb 10.

Authors

Jessica McCallum¹, Debra Eagles², Yongdong Ouyang³, Jamie Vander Ende⁴, Christian Vaillancourt⁵, Christophe Fehlmann⁶, Risa Shorr⁷, Monica Taljaard⁸, Ian Stiell⁹

Affiliations

¹ School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada; Department of Emergency Medicine, University of British Columbia, Vancouver, BC, Canada. Electronic address: j.harrismccallum@gmail.com.
² School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada; Department of Emergency Medicine, The University of Ottawa, Ottawa, Ontario, Canada. Electronic address: deagles@toh.ca.
³ School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada; Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada. Electronic address: youyang@ohri.ca.
⁴ College of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada. Electronic address: jamie.vanderende@usask.ca.
⁵ School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada; Department of Emergency Medicine, The University of Ottawa, Ottawa, Ontario, Canada. Electronic address: cvaillancourt@ohri.ca.
⁶ School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada; Department of Anaesthesiology, Clinical Pharmacology, Intensive Care and Emergency Medicine, Geneva University Hospitals, Geneva CH-1211, Switzerland. Electronic address: Christophe.FEHLMANN@hcuge.ch.
⁷ Learning Services, The Ottawa Hospital, Ottawa, Ontario, Canada. Electronic address: RSHORR@toh.ca.
⁸ School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada; Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada. Electronic address: mtaljaard@ohri.ca.
⁹ School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada; Department of Emergency Medicine, The University of Ottawa, Ottawa, Ontario, Canada. Electronic address: istiell@ohri.ca.

PMID: 36893628
DOI: 10.1016/j.ajem.2023.02.008

Abstract

Background: Adults ≥ 65 are at risk of cervical spine (C-spine) injury, even after low-level falls. The objectives of this systematic review were to determine the prevalence of C-spine injury in this population and explore the association of unreliable clinical exam with C-spine injury.

Methods: We conducted this systematic review according to PRISMA guidelines. We searched MEDLINE, PubMed, EMBASE, Scopus, Web of Science, and the Cochrane Database of Systematic reviews to include studies reporting on C-spine injury in adults ≥ 65 years after low-level falls. Two reviewers independently screened articles, abstracted data, and assessed bias. Discrepancies were resolved by a third reviewer. A meta-analysis was performed to estimate overall prevalence and the pooled odds ratio for the association between C-spine injury and an unreliable clinical exam.

Results: The search identified 2044citations, 138 full texts were screened, and 21 studies were included in the systematic review. C-spine injury prevalence in adults ≥ 65 years after low-level falls was 3.8% (95% CI: 2.8-5.3). The odds of c-spine injury in those with altered level of consciousness (aLOC) v/s not aLOC was 1.21 (0.90-1.63) and in those with GCS < 15 v/s GCS 15 was 1.62 (0.37-6.98). Studies were at a low-risk of bias, although some had low recruitment and significant loss to follow-up.

Conclusions: Adults ≥ 65 years are at risk of cervical spine injury after low-level falls. More research is needed to determine whether there is an association between cervical spine injury and GCS < 15 or altered level of consciousness.

Keywords: Aged; Diagnostic imaging; Falls; Spinal fractures.

Publication types

Meta-Analysis
Systematic Review
Review

MeSH terms

Adult
Cervical Vertebrae / injuries
Consciousness Disorders*
Humans
Spinal Injuries* / epidemiology
Spinal Injuries* / etiology