American College Of Surgeons - Inspiring Quality: Highest Standards, Better Outcomes

Spine-injury studies call for more imaging, less precautions

OCTOBER 25, 2017
Clinical Congress Daily Highlights, Wednesday First Edition

The annual incidence of spinal cord injuries (SCI) in the U.S. is about 12,500, but it may be increasing as more elderly patients experience ground-level falls. A pair of studies suggests that in treating elderly SCI patients after falls, management for these patient may differ from evaluation and treatment of a younger cohort.

The first study, led by Timothy J. Choi of the McGovern Medical School, Houston, TX, concluded that in choosing whether to image elderly patients, it may be better to err on the side of caution. Querying a trauma database, the researchers found 663 patients with cervical SCI. In the elderly, 44 percent of these were due to ground-level falls, compared with only 16 percent among younger patients. The authors conclude that because cervical SCIs are more than twice as likely in older patients after a ground-level fall, prehospital stabilization protocols and imaging guidelines should be more conservative in elderly patients.

A second study came to the conclusion that prolonged spinal precautions may increase the risk of immobility-associated morbidities such as pneumonia, urinary tract infection, deep vein thrombosis and pulmonary embolism, especially in the elderly. A team led by Katherine P. MacCallum, MD, of Jacobi Medical Center in Bronx, NY, studied 400 adult patients with a mean age of 54.5 years. The researchers found increased rates of immobility-associated morbidities in patients of all ages when spinal precautions lasted more than 72 hours (SP). They conclude that to avoid complications, efforts should be made to ensure timely management of spinal fractures in order to return the patients to mobility as soon as possible.

Additional Information:
The Scientific Forum presentations, Prolonged Use of Spinal Precautions Leads to Increased Morbidity in the Adult Trauma Patient without Neurologic Deficit and 'Unnecessary Imaging' in the Elderly is Necessary, were presented October 24 and 25 at the 2017 Clinical Congress of the American College of Surgeons in San Diego, CA. Program, webcast and audio information is available online at FACS.org/clincon2017.

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