CONTACT US: Contact info
|
Citation |
Hadley G, Billingsley S, Nakagawa S, Durkin C. Clin. Med. (Lond.) 2019; 19(5): 428-429. |
|
Affiliation |
Stoke Mandeville Hospital, Aylesbury, UK. |
|
Copyright |
(Copyright © 2019, Royal College of Physicians of London) |
|
DOI |
|
PMID |
31530702 |
|
Abstract |
We welcome the excellent review of head injury in the elderly1 in a recent edition of your journal. The important point is made that head injury often occurs from a standing height in older adults, however so too does cervical spine fracture.2 Indeed, the Canadian C-spine rules deem those at ‘high risk’ from a fracture to be those over the age of 65, those with extremity paraesthesia, or sustaining a dangerous mechanism of injury (fall from greater than three feet, axial load injury, road traffic accident, bicycle collision). According to this rule, the cervical spine cannot be clinically cleared if the patient fits any of the above criteria and imaging is recommended.3 Our local experience from a recent audit is that only 17% of patients over the age of 65 receiving a computed tomography head for a traumatic indication have their cervical spine imaged as well. A national audit of major trauma management in older people showed that current triage is not optimal for older people as they often get reviewed by more junior doctors than their younger counterparts.4 The advanced trauma life support (ATLS) guideline acknowledges that ‘airway’ always comes first but with the important adjunct of cervical spine protection.5 In our opinion, reference to the importance of cervical spine assessment in the management of head injury in older patients will lead to more appropriate and comprehensive imaging in a timely fashion thereby improving the outcome in these vulnerable patients. Language: en |