51 CT Head and Cervical Spine Audit in Patients Over the Age of 65: A District General Hospital Perspective

Abstract

Introduction Cervical spine (c-spine) injury has a high morbidity and mortalityin patients over the age of 65; more than 60% result from fallsfrom standing height (Beedham et al., 2019). The Canadian Cervical Spine Rule (Stiell et al., 2001) deems thatthere is a high risk of c-spine fracture if any of the followingapply: Age > 65 years Extremity paraesthesia Dangerous mechanism The c-spine cannot be cleared clinically if the patient fits any of the above criteria. Imaging should be considered. As a result of recent clinical experiences Trust Guidelines at Stoke MandevilleHospital now reflect this evidence (Hadley et al., 2019). Methods Fifty patients over the age of 65 who had a computerisedtomography (CT) head scan in the Emergency Department (ED)following a traumatic head injury were randomly selected over a1 month period. Cases were checked for examination of c-spineand/or CT c-spine. Results of the first cycle of the audit werepresented at an ED Education Meeting. Indications for CT c-spinewere displayed in poster format around the ED. Following theseinterventions, a re-audit was carried out using the samemethodology. Results In fifty patients aged over 65 attending ED during one month, 16%had a CT c-spine in addition to a CT head. There was documentedc-spine examination of 16% of those without CT c-spine onadmission. In the re-audit 38% of the fifty patients who had a CThead underwent CT c-spine. In the group that did not haveimaging of the c-spine, the proportion with documented cervicalspine examination on admission remained the same (16%). Conclusion There was a 137.5% increase in the number of patients aged over65 who appropriately underwent a CT c-spine as per Trust and National guidelines. Simple interventions (staff education and posters within the ED) were sufficient to significantly alterpractice. Current trauma triage is not optimal for older patientswho are reviewed by more junior doctors, less likely to betransferred to Major Trauma Centres and more likely to die thanyounger patients with similar injuries (Major Trauma In OlderPeople 2017 Report). An older person's trauma team in ED withage-appropriate triage would lead to appropriate imaging in atimely fashion, potentially improving the morbidity and mortality of these vulnerable patients.