title: Application of National Emergency X-Ray Utilizations Study low-risk c-spine criteria in high-risk geriatric falls.
abstract: OBJECTIVE
  We sought to validate National Emergency X-Radiography Utilizations Study low-risk cervical spine (C spine) criteria in a geriatric trauma population. We sought to determine whether patients' own baseline mental status (MS) could substitute for Glasgow Coma Scale (GCS) to meet the criteria "normal alertness." We further sought to refine the definition of "distracting injury."
  
  
  METHODS
  This is a retrospective review of geriatric fall patients presenting to a level 1 trauma center and triaged to the trauma bay. We queried our database from 2008 to 2013. Abstractors recorded GCS, deviation from baseline MS, midline neck tenderness, intoxication, focal deficit, signs of trauma, and presence of other injury. Patients were considered at baseline MS if specific documentation was present on the chart, or if their GCS was 15.
  
  
  RESULTS
  Six hundred sixty elderly fall patients were trauma alerts during the study period. Seventeen were excluded for incomplete records/death before imaging, leaving 647. The median age was 81 (interquartile range, 74-87). Fifty patients (8.0%) had C spine or cord injury. Two hundred ninety-four (44.5%) had baseline MS (including GCS 13-15), no spine tenderness, no intoxication, and no focal neurologic deficit. Of these, 18 had C-spine injury. Using physical findings of head trauma as the only "distracting injury," no injury would have been missed (sensitivity, 100% [confidence interval, 91.1-100]; specificity, 14.2%).
  
  
  CONCLUSIONS
  Our study suggests that National Emergency X-Radiography Utilizations Study can be safely applied in elderly fall patients who are at their personal baseline MS. Furthermore, our data support a more narrow definition of distracting injury to include only patients with signs of trauma to the head.
authors.affiliation: St Luke's University Hospital, 801 Ostrum St, Bethlehem, PA 18015, USA.
authors.forename: Daniel
authors.initials: D
authors.lastname: Evans
authors.affiliation: St Luke's University Hospital, 801 Ostrum St, Bethlehem, PA 18015, USA.
authors.forename: Luis
authors.initials: L
authors.lastname: Vera
authors.affiliation: St Luke's University Hospital, 801 Ostrum St, Bethlehem, PA 18015, USA.
authors.forename: Donald
authors.initials: D
authors.lastname: Jeanmonod
authors.affiliation: St Luke's University Hospital, 801 Ostrum St, Bethlehem, PA 18015, USA.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Pester
authors.affiliation: St Luke's University Hospital, 801 Ostrum St, Bethlehem, PA 18015, USA. Electronic address: rebeccajeanmonod@yahoo.com.
authors.forename: Rebecca
authors.initials: R
authors.lastname: Jeanmonod
mesh_terms: D000058:Accidental Falls; D000368:Aged; D000369:Aged, 80 and over; D002574:Cervical Vertebrae / Q000000981:diagnostic imaging* / Q000293:injuries*; D006259:Craniocerebral Trauma / Q000000981:diagnostic imaging; D003661:Decision Support Techniques; D005151:Facial Injuries / Q000000981:diagnostic imaging; D005260:Female; D015600:Glasgow Coma Scale; D006801:Humans; D008297:Male; D011859:Radiography; D012189:Retrospective Studies; D012307:Risk Factors; D014193:Trauma Centers; D014481:United States; D014949:Wounds, Nonpenetrating / Q000150:complications; D014965:X-Rays