Detected and overlooked cervical spine injury among comatose trauma patients: from the Pennsylvania trauma outcomes study

Object A rule for identifying patients with traumatic brain injury (TBI) who are at exceptionally low risk of cervical spine injury might be clinically useful. The goal in this study was to research case records to determine whether such a rule would be practicable. Methods The Pennsylvania Trauma Outcomes Study database was used to find patients with TBI in whom Glasgow Coma Scale (GCS) scores at admission were 8 or less. Cases of cervical spine injury were identified from diagnostic codes. Associations between these injuries and a variety of clinical variables were tested using chi-square analysis. The probability of a cervical spine injury in these patients was modeled by logistic regression. Decision tree models were constructed and statistical determinants of overlooked cervical spine injury were examined. The prevalence of cervical spine injury among 41,142 cases of TBI was 8%. The mechanism of injury, presence of thoracolumbosacral (TLS) spinal, limb and/or facial fracture, patient age, GCS score at admission, and the presence of hypotension were all factors associated with cervical spine injury. These were incorporated into the following logistic regression model: probability of cervical spine injury = 1/(1 + exp[4.030 − 0.417*mechanism − 0.264*age − 0.678*TLS − 0.299*limb + 0.218*GCS score − 0.231*hypotension − 0.157*facial]). This model yielded a rule for clearance of 28% of cases, with a negative predictive value (NPV) of 97%. Decision tree analysis yielded an easily stated rule for clearance of 24% of cases, with an NPV of 98.2%. The prevalence of overlooked cervical spine injury among all patients with severe TBI was 0.3%; the prevalence of overlooked cervical spine injury among patients in whom it was later diagnosed was 3.9%. Overlooked cervical spine injury was less common among patients with associated TLS fractures (odds ratio 0.453, 95% confidence interval 0.245–0.837). Conclusions No acceptable rule for relaxation of vigilance in the search for cervical spine injury among patients with severe TBI has been identified. Levels of provider vigilance and consequent rates of overlooked cervical spine injury can be affected by environmental cues and presumably by other behavioral and organizational factors.

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Detected and overlooked cervical spine injury in comatose victims of trauma: report from the Pennsylvania Trauma Outcomes Study

Journal of Neurosurgery Spine ◽

10.3171/spi.2006.5.3.210 ◽

2006 ◽

Vol 5 (3) ◽

pp. 210-216 ◽

Cited By ~ 17

Author(s):

Joseph H. Piatt

Keyword(s):

Logistic Regression ◽

Cervical Spine ◽

Decision Tree ◽

Cervical Spine Injury ◽

Spine Injury ◽

Cervical Injury ◽

Trauma Outcomes ◽

Severe Tbi ◽

Outcomes Study ◽

Gcs Score

Object This study was undertaken to determine whether a clinically useful rule could be formulated for identifying the presence of traumatic brain injury (TBI) in patients who are at exceptionally low risk of cervical spine injury. Methods The Pennsylvania Trauma Outcomes Study database was searched for cases of TBI in which the admission Glasgow Coma Scale (GCS) score was less than or equal to 8. Cases of cervical injury were identified based on diagnostic codes. Associations between cervical injury and various clinical variables were tested using chi-square analysis. The probability of cervical injury was modeled using logistic regression. Decision tree models were constructed. Statistical determinants of overlooked cervical injury were examined. The prevalence of cervical injury among 41,142 cases of TBI was 8%. Mechanism of injury, thoracolumbosacral (TLS) fracture, age, limb fracture, admission GCS score, hypotension, and facial fracture were associated with cervical injury and were incorporated into the following logistic regression model: probability = 1 / (1 + exp[4.248 − 0.417 × mechanism −0.264 ×age −0.678 ×TLS −0.299 ×limb −0.218 ×GCS −0.231 ×hypotension −0.157 ×facial]). The results of applying this model provided a rule for cervical spine clearance applicable to 28% of the cases with a negative predictive value (NPV) of 97.0%. Decision tree analysis yielded a rule applicable to 24% of the cases with an NPV of 98.2%. The prevalence of overlooked cervical injury in all individuals with severe TBI was 0.3%; the prevalence of overlooked cervical injury in patients with cervical injury was 3.9%. Overlooked cervical injury was less common in patients with associated TLS fractures (odds ratio 0.453, 95% confidence interval 0.245–0.837). Conclusions This analysis identified no acceptable rule to justify relaxing vigilance in the search for cervical injury in patients with severe TBI. Provider vigilance and consequent rates of overlooked cervical injury can be affected by environmental cues and presumably by other behavioral and organizational factors.

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Detected and overlooked cervical spine injury in comatose victims of trauma: report from the Pennsylvania Trauma Outcomes Study

Yearbook of Diagnostic Radiology ◽

10.1016/s0098-1672(08)70242-x ◽

2007 ◽

Vol 2007 ◽

pp. 361-362

Author(s):

A.G. Osborn

Keyword(s):

Cervical Spine ◽

Cervical Spine Injury ◽

Spine Injury ◽

Trauma Outcomes ◽

Outcomes Study

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Neurotrauma at the All India Institute of Medical Sciences Bhubaneswar: An Overview

Indian Journal of Neurotrauma ◽

10.1055/s-0039-3402822 ◽

2019 ◽

Vol 16 (02/03) ◽

pp. 113-116

Author(s):

Chinmaya Dash ◽

Ayusman Satapathy ◽

Sumit Bansal ◽

Rabi Narayan Sahu

Keyword(s):

Cervical Spine ◽

Cervical Spine Injury ◽

Traffic Accidents ◽

Road Traffic ◽

India Institute ◽

Spine Injury ◽

Road Traffic Accidents ◽

Medical Sciences ◽

The Future ◽

Severe Tbi

Abstract Background The All India Institute of Medical Sciences (AIIMS) Bhubaneswar was established as an Institution of National Importance through the All India Institute of Medical Sciences (Amendment) Ordinance passed on July 16, 2012. It is estimated that road traffic accidents lead to economic loss to the tune of approximately 3% of gross domestic product. Centers of excellence for neurotrauma are the need of the hour, and the Indian Government is focusing on preventive and curative aspects of road traffic accidents to a great extent in the recent years. In this article, we would like to highlight the resources (manpower, infrastructure, etc.) available for neurotrauma, challenges ahead, and vision for the future. Trauma Audit A retrospective analysis of all the admitted patients of traumatic brain injury (TBI) was performed from November 2018 to October 2019. A total of 149 patients were admitted during this period. Of the 149 admitted patients, 88 had mild TBI, 39 had moderate TBI, and 22 had severe TBI. The mortality was highest in patients with severe TBI, with 45.45% mortality. A total of 29 patients with traumatic spine injury were admitted during this period. Of the 29 patients, 10 had cervical spine injury, 10 had dorsal spine injury, and 9 had lumbar spine injury. Of all these patients, two patients with cervical spine injury died of refractory shock. Perceived Limitations and Challenges Lack of dedicated round-the-clock emergency operating rooms (ORs) for neurosurgical procedures, adequate number of intensive care unit (ICU) beds, various gadgets in the ICU for neurocritical care, lack of rehabilitation facilities/center, lack of various OR gadgets, and lack of manpower, especially trained nursing staff, are the limitations perceived by us. Vision for the Future A trauma block has been approved, and work on it has begun. This shall greatly help in upgrading facilities for neurotrauma at AIIMS, Bhubaneswar. Conclusion Facilities for neurotrauma at AIIMS Bhubaneswar are gradually being upgraded. With a core team, the services are improving gradually. However, the institution is in its early years, and a lot more needs to be done in terms of manpower, gadgets, and infrastructure to further improve neurotrauma care at AIIMS, Bhubaneswar. This article may help in formulating guidelines for strengthening neurotrauma facilities in AIIMS, Bhubaneswar and all the new AIIMS established in India.

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