Patients with learning disabilities should be considered at high risk of cervical spine injury

Dear Editor,

The use of decision tools, such as the Canadian C-spine rule, to identify patients who do not require imaging after trauma is widespread.1 The C–spine rule has been found to be sensitive for cervical spine injury.2 However, these tools do not consider patients who may have difficulty describing pain or have sensory processing problems, or those who may be at risk of a fragility fracture unrelated to age.

The risk of fragility fracture increases in patients with prolonged immobilisation or inactivity (eg, wheelchair users), patients who are malnourished or underweight and those with poor neuromuscular function.3 4 In addition, a variety of learning disabilities are associated with congenital spinal abnormalities, an increased risk of osteopenia and fragility fractures.5 6

History taking in patients with learning disabilities can be complicated by cognitive impairment. The interpretation of examination...

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