Original Contributions
Epidemiology of cervical spine injury victims*,**,*

https://doi.org/10.1067/mem.2001.116149Get rights and content

Abstract

Study Objective: We sought to characterize demographics and injury patterns among patients undergoing emergency department cervical spine radiography for blunt traumatic injury. Methods: All patients with blunt trauma undergoing cervical spine radiography at 21 centers were enrolled in this prospective, observational study. Patients’ date of birth, age, sex, and ethnicity were noted before cervical spine radiography. Results: Demographic factors associated with cervical spine injury, present in 818 of 33,922 patients, included the following: age of 65 years or older (relative risk [RR] 2.09; 95% confidence interval [CI] 1.77 to 2.59); “other” ethnicity (RR 1.79, 95% CI 1.46 to 2.19); male sex (RR 1.72, 95% CI 1.48 to 2.00); and white ethnicity (RR 1.50, 95% CI 1.31 to 1.72). Hispanic ethnicity (RR 0.64, 95% CI 0.51 to 0.79), female sex (RR 0.58, 95% CI 0.50 to 0.67), black ethnicity (RR 0.55, 95% CI 0.45 to 0.66), and age of less than 18 years (RR 0.39, 95% CI 0.27 to 0.55) were associated with reduced risk of cervical spine injury. Conclusion: Among patients undergoing ED cervical spine radiography, cervical spine injury is more common among the elderly, male subjects, and patients of white or “other” ethnicity. Because cervical spine injury occurs in patients in all demographic categories, however, this information cannot be used to select individual patients who should or should not undergo imaging.[Lowery DW, Wald MM, Browne BJ, Tigges S, Hoffman JR, Mower WR, for the NEXUS Group. Epidemiology of cervical spine injury victims. Ann Emerg Med. July 2001;38:12-16.]

Introduction

Cervical spine injury is relatively rare, occurring in only 2% to 3% of patients with blunt trauma who undergo imaging studies.1, 2, 3 Existing epidemiologic studies of patients with cervical spine injury typically focus on admitted patients or populations seen at referral centers. The spectrum of cases seen in such studies may not represent the patterns of patients or injuries seen in most emergency departments.4, 5, 6, 7, 8, 9, 10, 11, 12 More reliable and detailed descriptions of cervical spine injury patterns may ultimately facilitate the development of preventive measures and interventions that could enhance injury detection.

We designed this prospective substudy of the National Emergency X-Radiography Utilization Study (NEXUS) database to characterize the prevalence and distribution of cervical spine injury among various patient demographic groups.

Section snippets

Materials and methods

We performed a secondary analysis of the NEXUS relational database. A detailed description of this study and its methodology are included elsewhere, including a separate report in this issue.13, 14 Briefly, NEXUS was a prospective, observational study performed with institutional review board approval at 21 diverse EDs in the United States. The study included all patients with blunt trauma who underwent cervical spine radiography in the participating EDs at the discretion of the treating

Results

Enrolled in the study were 33,922 patients with blunt trauma who underwent 34,069 radiographic evaluations. Cervical spine injury was present in 818 (2.40%) patients. The majority of the enrolled patients were male subjects (male 58.7%, female 41.3%), as were the majority of patients with cervical spine injury (male 70.9%, female 29.1%).

Enrollment rates varied by age (Figure 1 and Table 1), with relatively few very young (age <16 years) or very old (age >65 years) patients undergoing imaging.

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Discussion

Reports from prior cervical spine injury surveys suffer from a lack of generalizability because they rely on data from single institutions or subpopulations, focus only on admitted patients, fail to discriminate between cervical and thoracolumbar spine injuries, or some combination thereof.4, 5, 6, 7, 8, 9, 10, 11 The NEXUS cohort provides the largest and most representative database regarding the epidemiology of cervical spine injury patterns. It provides evidence that cervical spine injury

Acknowledgements

Author contributions: DWL, JRH, and WRM conceived the study, designed the trial, and analyzed and interpreted the data. DWL, MMW, BJB, ST, JRH, and WRM participated in the acquisition of data and provided administrative and technical support. JRH and WRM provided the statistical expertise and obtained funding. DWL drafted the manuscript. DWL, MMW, BJB, ST, JRH, and WRM contributed materially to its revision. DWL takes responsibility for the paper as a whole.

We thank Guy Merchant, NEXUS Project

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Author contributions are provided at the end of this article.

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Supported by grant No. R01 HS08239 from the Agency for Healthcare Research and Quality, formerly the Agency for Health Care Policy and Research.

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Address for reprints: Douglas W. Lowery, MD, Emergency Department, Emory University Hospital, 1364 Clifton Road NE, B-176, Atlanta, GA 30322; 404-712-0448,fax 404-712-4561;,E-mail [email protected].

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