P133 NICE Guidance 41: Is it applicable to a real-world cohort of cervical spine fractures in older people?

Abstract

Abstract Background/Aims Current guidance for the assessment and management of cervical spine fractures (CSFracs) in the UK is governed by NICE Guidance 41 (NG41). The guidance is based on the Canadian C-Spine Rule (CCR) which dictates whether spine imaging is necessary following trauma. There is little research into the reliability of NG41, notably on low energy impacts resulting in CSFracs in the elderly. The consequence of weaknesses in NG41 may result in delayed or missed CSFracs. Therefore, this report will deconstruct NG41 to identify potential areas of improvement. Methods Data were collected from medical notes on mechanism of injury and self-reported symptoms at The Royal Devon and Exeter Hospital in 84 patients >50 years old with confirmed CSFracs over a 4-year period. Quantitative and thematic analysis of data was used to compare with this cohort with NG41. The comparison focussed on age, symptoms and the mechanism of injury. Results Of the 84 patients, 32.1% were reported as having a dangerous mechanism of injury. 74.6% of patients aged ≥65 were considered low risk for CSFracs. Neck pain was reported by 74.5% of patients. Only 6.0% presented with paraesthesia as a predominant symptom. Conclusion The significant proportion of patients aged ≥65 considered low risk for CSFracs emphasises changes are required to NG41 to include low energy impacts in the guidance. Age remains to have the strongest correlation with CSFracs. Neck pain is the predominant symptom in the data but has no mention in NG41. Larger scale research and modified guidance testing is required before changes to NG41 can be made. Disclosure D. Mony: None. F. Gilbert: None.