Routine or Required? Reassessing Cervical CT Use in Geriatric Head Trauma-A Retrospective Analysis From a German Level I Trauma Center.

Abstract

Retrospective analysis of cervical spine injuries (CSI) after a head impact in a geriatric cohort. Geriatric patients with head trauma have an increased risk of consecutive CSIs. Due to reduced clinical accessibility, computer tomography (CT) is frequently performed. The relevance of routine cervical spine CT imaging in addition to cranial computer tomography (cCT) remains unclear. This study calculates the prevalence, risk factors, and the number needed to screen (NNS) for consecutive CSIs following head trauma in a geriatric cohort. A retrospective analysis was conducted on patients aged 65 years or older presenting to a level I trauma centre in Germany between January 2020 and October 2024, undergoing both cCT and cervical spine CT imaging after a head impact. Among 2157 patients, 55.9% were female and 63.6% aged older than or equal to 80 years. Sensomotoric deficits were detected in 1.5%. CSIs were identified in 5.5%, with 10.9% of those requiring operation. Identified risk factors included female gender (OR=1.6; P=0.006), pre-existing dementia (OR=1.4, P=0.01), admission via resuscitation room (OR=1.6; P=0.05) and intracranial bleeding (OR=1.5; P=0.03). The NNS to detect a CSI was 18.1 for patients aged older than or equal to 65 years and 17.6 for those aged older than or equal to 80 years. For asymptomatic patients, the NNS was 19.3 for those aged older than or equal to 65 years and 18.5 for those aged older than or equal to 80 years. The NNS for operation was 165.9 in patients aged older than or equal to 65 years and 171.4 in those aged older than or equal to 80 years. Concomitant CSIs are common in geriatric head trauma. Routine cervical spine CT imaging should be considered when cCT is indicated, as it enables the timely identification of CSI and directly influences clinical decision-making. The low NNS highlights the value of routine cervical spine CT imaging, supporting its broader implementation to prevent complications and improve patient outcomes. Level III-survey.