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

2006 ◽  
Vol 5 (3) ◽  
pp. 210-216 ◽  
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.

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

2005 ◽  
Vol 19 (4) ◽  
pp. 1-7 ◽  
Author(s):  
Joseph H. Piatt
Keyword(s):  
Logistic Regression ◽  
Cervical Spine ◽  
Decision Tree ◽  
Cervical Spine Injury ◽  
Spine Injury ◽  
Trauma Outcomes ◽  
Severe Tbi ◽  
Outcomes Study ◽  
Gcs Score ◽  
Chi Square Analysis

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.

scholarly journals LO027: Cervical spine injury in trauma patients 65 years and older immobilised in the prehospital setting

CJEM ◽  
2016 ◽  
Vol 18 (S1) ◽  
pp. S39-S39
Author(s):  
L. Lamy ◽  
J. Chauny ◽  
D. Ross
Keyword(s):  
Cervical Spine ◽  
Cervical Spine Injury ◽  
Fracture Dislocation ◽  
Spine Injury ◽  
Trauma Patients ◽  
Minor Trauma ◽  
Cervical Injury ◽  
Geriatric Population ◽  
Spinal Immobilisation ◽  
A Minor

Introduction: Following a protocol derived from the Canadian C-spine Rule (CCR), patients 65 years and older transported by ambulance after trauma require full spinal immobilisation. Immobilisation complicates the transport and the evaluation; potential side effects have been recognized. The aim of this study was to evaluate the effect of mechanism of trauma and age on the rate of cervical injury in a geriatric population. Methods: We conducted a retrospective observational study on patients 65 years and older transported by ambulance to a level-one trauma center from March 2008 to October 2013. The outcome was the rate of clinically important cervical spine injury (CICSI), defined as any fracture, dislocation or ligamentous injury needing treatment or specialised follow up. The rate was calculated in the geriatric population and in the subgroup of patients with minor trauma, defined as a fall from a standing height, a chair or a bed. We then looked at the rate of CICSI based on age to define a subgroup at lower risk of lesion. Results: We included 1221 patients with a mean age of 80 y.o. (SD = 8), 739 women (61%). CICSI was found in 53 patients (4.3%, 95% CI 3.2-5.4). This is similar to the rate found in patients 65 years and older in the NEXUS population (4.6%) and the CCR population (6.0%). The mechanism of injury was a minor trauma for 716 patients (59%). Of those, 24 patients (3.4%, 95% CI 2.1-4.7) had CICSI. The rate increased after 85 y.o in both the overall population (3.4% vs 6.4%) and the minor trauma subgroup (2.6% vs 4.4%). Conclusion: The subgroup of patients 65-84 y.o. with a minor trauma had the lower rate of cervical spine injury (2.6%). In a lot of prehospital systems, those patients are not systematically immobilised for transport. It will be interesting to review the files of all patients with CICSI to identify any possible case that would have been missed without the age criteria.

scholarly journals Cervical Spine Clearance: A Review and Understanding of the Concepts

2008 ◽  
Vol 47 (172) ◽  
Author(s):  
Amit Agrawal
Keyword(s):  
Cervical Spine ◽  
Cervical Spine Injury ◽  
Pediatric Trauma ◽  
Spine Injury ◽  
Team Approach ◽  
Optimal Management ◽  
Imaging Studies ◽  
Cervical Injury ◽  
Cervical Spine Injuries ◽  
Spine Injuries

Cervical spine injury is relatively rare, occurring in only 2% to 3% of patients with blunt traumawho undergo imaging studies. However, timely and accurate recognition of cervical spine injuryis essential for the optimal management of patients with blunt trauma as subsequent morbidity includesprolonged immobilization. Evaluation of cervical spine injuries should begin in the emergencydepartment and involves a combination of pediatric, trauma, orthopedic, and neurosurgeons fordefinitive management. Knowing which patients are at highest risk for injuries will undoubtedlyinfluence decisions on how aggressively to pursue a potential cervical spine injury and can be achievedby establishing a multidisciplinary team approach that provides cervical spine immobilization,assessment, and clearance. Implementation of such guidelines will decrease time for cervical spineclearance and incidence of missed injuries. In this article different aspects of cervical spine injuriesand cervical spine clearance protocols are reviewed.Key words: cervical, injury, trauma, spine, vertebrae

scholarly journals Bilateral facet effusion is a risk factor for segmental instability with cervical injury without vertebral fracture

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Shinji Tanishima ◽  
Tokumitsu Mihara ◽  
Shinya Ogawa ◽  
Chikako Takeda ◽  
Satoshi Fujiwara ◽  
...  
Keyword(s):  
Cervical Spine ◽  
Vertebral Fracture ◽  
Cervical Spine Injury ◽  
Facet Joint ◽  
Joint Effusion ◽  
Spine Injury ◽  
Cervical Injury ◽  
Segmental Instability ◽  
Group A ◽  
Group B

AbstractMagnetic resonance imaging (MRI) is effective in identifying cervical spine injury after trauma. However, cervical instability without major bone injury or dislocation is challenging to assess. Hence, the current study aimed to investigate and compare the MRI and radiography findings of segmental instability in patients with cervical spine injury. We investigated 34 participants with cervical spine injury without vertebral fracture. Based on the radiography findings, the participants were categorized into two: group A with segmental instability (n = 11) and group B without segmental instability (n = 23). Both groups were compared in terms of the presence of segmental instability on radiography and MRI. Anterior longitudinal ligament (ALL) injury, disc injury, and bilateral facet effusion were observed in 6/11, 5/11, and 7/11 patients in group A and in 5/23, 2/23 and 7/23 patients in group B, respectively. The results showed significant differences (p < 0.05). Moreover, 2 and 10 of 11 patients in group A and 16 and 7 of 23 patients in group B presented with hemi lateral facet effusion and paravertebral muscle injury, respectively. However, the results did not significantly differ. According to a logistic regression analysis, bilateral facet effusion after trauma was associated with cervical segmental instability (odd ratio: 10.6, 95% confidence interval: 1.31–84.7). Facet joint effusion might be caused by capsule injury during trauma. Most participants with segmental instability had ALL, disc, and flavum injury and bilateral facet effusion. Therefore, we need to consider bilateral facet effusion with other soft tissue damage of the cervical spine as an association factor to show the instability.

LITIGATION OF MISSED CERVICAL SPINE INJURIES IN PATIENTS PRESENTING WITH BLUNT TRAUMATIC INJURY

Neurosurgery ◽  
2007 ◽  
Vol 60 (3) ◽  
pp. 516-523 ◽  
Author(s):  
Gregory P. Lekovic ◽  
Timothy R. Harrington
Keyword(s):  
Cervical Spine ◽  
Cervical Spine Injury ◽  
Traumatic Injury ◽  
Delayed Diagnosis ◽  
Spine Injury ◽  
Type I ◽  
Type Ii ◽  
Cervical Injury ◽  
Cervical Spine Injuries ◽  
Delays In Diagnosis

Abstract BACKGROUND Approximately 800,000 cervical spines are cleared in emergency departments each year. Errors in diagnosis of cervical spine injury are a potentially huge medicolegal liability, but no established protocol for clearance of the cervical spine is known to reduce errors or delays in diagnosis. METHODS The Lexis-Nexis, Westlaw, and Medline databases were queried for cases of missed cervical injury. Errors were categorized according to a novel system of classification. Type I errors occurred when inadequate or improper tests were ordered. Type II errors occurred when adequate tests were ordered, but were either misread or not read. Type III errors occurred when adequate tests were ordered and read accurately, but the ordered test was not sensitive enough to detect the injury. RESULTS Twenty cases of missed or delayed diagnosis of cervical spine injury were found in 10 jurisdictions. Awards averaged $2.9 million (inflation adjusted to 2002 dollars). Eight cases resulted in verdicts in favor of the defendant, but none of these cases involved an alleged Type II error. CONCLUSION Fear of lawsuits encourages defensive medicine and complicates the process of clearing a patient's cervical spine. This analysis adds medicolegal support for the judicious use of imaging studies in current cervical spine clearance protocols. However, exposure to significant liability suggests that a low threshold for computed tomography is a reasonable alternative.

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

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.

scholarly journals Sports-Related Cervical Spine Fracture and Spinal Cord Injury: A Review of Nationwide Pediatric Trends

Neurosurgery ◽  
2019 ◽  
Vol 66 (Supplement_1) ◽  
Author(s):  
Haddy Alas ◽  
Avery Brown ◽  
Katherine Pierce ◽  
Cole Bortz ◽  
Michael Moses ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Cervical Spine ◽  
Martial Arts ◽  
Cervical Spine Injury ◽  
Sports Injuries ◽  
Spine Injury ◽  
Cervical Injury ◽  
Injury Type ◽  
Cord Injury

Abstract INTRODUCTION As youth athletic sports continue to be played at a highly competitive level, more attention is called to potentially fatal cervical spine injuries. METHODS KID was queried for patients with E-Codes (ICD-9-CM codes) pertaining to external causes of injury secondary to sports-related activities from 2003 to 2012. Patients were further grouped by cervical spine injury type [C 1-4 and C 5-7 fracture with and without spinal cord injury (SCI), dislocation, and SCI without radiographic abnormality (SCIWORA). Patients were grouped by age into children (4-9), preadolescents (pre,10-13), and adolescents (14-17). Sports included by E-Code: American football, other team sports, individual, winter, water, and martial arts. Kruskall–Wallis tests with posthocs identified differences in cervical injury type across age groups and sports. Logistic regression assessed predictors of traumatic brain injury (TBI) and cervical injury type. RESULTS A total of 38 539 pts with sports injuries were identified (12.76 yr, 24.5% F). Adolescents had the highest rate of sports injuries per year, but rates decreased in pre and adolescents and increased in children. Adolescents had the highest rate of any type of cervical spine injury and TBI. Adolescence increased odds for C 1-4 fx with and without SCI, C 5-7 fx with and without SCI, cervical dislocation, and cervical SCIWORA (all P < .05). Cervical fx of any type tended to occur in disproportionately higher rates via team, winter, or water sports (P < .001). Martial arts had significantly higher rates of cervical dislocations compared to other sports (P = .039). Football injuries rose from 5.83% to 9.14% (2009-2012) (P < .001) and had significantly more SCIWORA than non-football sports (1.6 vs 1.0%, P = .012). Football increased odds of SCI by 1.56x compared to any other sport (OR: 1.56 [1.11-2.20], P = .011). SCIWORA was a significant predictor for concurrent TBI across all sports (OR: 2.35[1.77-3.11], P < .001). CONCLUSION Adolescent athletes had the highest rates of upper/lower cervical fracture, dislocation, and SCIWORA. Adolescence and SCIWORA were significant predictors of concurrent TBI across sports.

scholarly journals The Outcome of Cervical Spine Injury Associated with Traumatic Brain Injuries: Tertiary Care Hospital Study

2021 ◽  
pp. 763-768
Author(s):  
Sher Hassan ◽  
Aurangzeb Kalhoro ◽  
Lal Rehman ◽  
Abdul Samad
Keyword(s):  
Cervical Spine ◽  
Head Injury ◽  
Cervical Spine Injury ◽  
Severe Head Injury ◽  
Brain Injuries ◽  
Tertiary Care ◽  
Traumatic Brain Injuries ◽  
Spine Injury ◽  
Care Hospital ◽  
Cervical Injury

Objective:  Outcome of cervical spine injury associated with traumatic brain injuries. Materials & Methods: This study is a cross-sectional descriptive study that was performed at the Jinnah Post Graduate Medical Centre, Karachi. 158 total patients were included in the study, this study by non-probability consecutive sampling. The diagnosis was based primarily on a CT scan brain plain and an x-ray of the cervical spine of all the patients who were admitted to the ward. Results: Among 158, the age distribution of the patient was observed as 43(27%)patients presented as less than 20 years, 32(20%) were between the age of 21-30 years range, 28(18%) patients were ranged between 31-40 years, 16(10%) patients aged in a range of 41-50 years while 39(25%) were above 50 years. Head injury severity was observed at 47% as mild head injury, 32% as moderate injury and 21% had a severe head injury while cervical injury in association with traumatic brain injury was found in 10% of patients. Conclusion: The prevalence of cervical traumatic injury associated with moderate to severe head injury remained similar in the world overall with minute differences in the percentages that we have noticed in our study. The severity of the head injury is directly proportional to cervical injury.

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