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Emergency management of older people with cervical spine injuries: an expert practice review
  1. Sandy Benchetrit1,
  2. Jules Blackham1,
  3. Philip Braude2,
  4. Ruth Halliday3,
  5. David Shipway2,
  6. Adam Williams4,
  7. Edward Carlton1
  1. 1 Emergency Department, Southmead Hospital, Bristol, UK
  2. 2 Department of Medicine for Older People, Southmead Hospital, Bristol, UK
  3. 3 Trauma & Orthopaedic Research Team, Southmead Hospital, Bristol, UK
  4. 4 Department of Neurosurgery, Southmead Hospital, Bristol, UK
  1. Correspondence to Dr Sandy Benchetrit, Emergency Department, Southmead Hospital, Bristol BS10 5NB, UK; sandy.benchetrit{at}


Spinal fractures are the third most common traumatic injury in older people, of which cervical spine injuries make up around 15%. They are predominantly seen in people living with frailty who fall from standing height. Spinal fractures in this patient group are associated with substantial morbidity and mortality (over 40% at 1 year). For many older people who survive, their injuries will be life changing. Practice between EDs varies significantly, with no universally accepted guidelines on either assessment, investigation or management specific to older people experiencing trauma. This expert practice review examines the current evidence and emergency management options in this patient group through clinical scenarios, with the aim of providing a more unified approach to management.

  • trauma
  • spine and pelvis
  • frailty
  • trauma
  • emergency department management
  • accidental falls

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  • Handling editor Mary Dawood

  • Twitter @BenchetritSandy, @julesblackham, @DrPhilipBraude, @ruth_halliday, @adampwilliams13, @EddCarlton

  • Contributors EC planned the manuscript following invitation from the editorial board and guarantees the overall content. SB, JB, PB, RH, DS, AW and EC contributed equally to the manuscript content and approved final submission.

  • Funding PB is directly funded by the Research Capability Funding North Bristol Trust Research and Innovation Department and EC by the NIHR Advanced Fellowship.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.