Can emergency physicians accurately rule out clinically important cervical spine injuries by using computed tomography?

ABSTRACT Objective: Emergency physicians are expected to rule out clinically important cervical spine injuries using clinical skills and imaging. Our objective was to determine whether emergency physicians could accurately rule out clinically important cervical spine injuries using computed tomographic (CT) imaging of the cervical spine. Method: Fifteen emergency physicians were enrolled to interpret a sample of 50 cervical spine CT scans in a nonclinical setting. The sample contained a 30% incidence of cervical spine injury. After a 2-hour review session, the participants interpreted the CT scans and categorized them into either a suspected cervical spine injury or no cervical spine injury. Participants were asked to specify the location and type of injury. The gold standard interpretation was the combined opinion of two staff radiologists. Results: Emergency physicians correctly identified 182 of the 210 abnormal cases with cervical spine injury. The sensitivity of emergency physicians was 87% (95% confidence interval [CI] 82–91), and the specificity was 76% (95% CI 74–77). The negative likelihood ratio was 0.18 (95% CI 0.12–0.25). Conclusion: Experienced emergency physicians successfully identified a large proportion of cervical spine injuries on CT; however, they were not sufficiently sensitive to accurately exclude clinically important injuries. Emergency physicians should rely on a radiologist review of cervical spine CT scans prior to discontinuing cervical spine precautions.

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Neck Injury

Pediatrics in Review ◽

10.1542/pir.16.1.28 ◽

1995 ◽

Vol 16 (1) ◽

pp. 28-28

Author(s):

Jeffrey R. Avner

Keyword(s):

At Risk ◽

Cervical Spine ◽

Cervical Spine Injury ◽

Pediatric Patients ◽

Neck Injury ◽

Spine Injury ◽

Clinical Markers ◽

Cervical Spine Injuries ◽

Spine Injuries ◽

Spine Radiographs

Although rare in pediatrics, cervical spine injuries still are associated with serious morbidity, disability, and mortality. Many of these injuries are exacerbated by inadequate neck immobilization or improper manipulation. Thus, the physician should be aware of which children are at risk for cervical spine injury and how to assess these patients properly. To find clinical markers that identify children who actually have cervical spine injuries, Rachesky et al reviewed 2133 cervical spine radiographs obtained in pediatric patients during a 7-year period. Of these children, 25 (1.2%) had abnormalities confirmed on radiographs. The incidence of injury increased with age; only four of the children who had cervical spine injuries were less than 8 years old.

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Screening cervical spine MRI after normal cervical spine CT scans in patients in whom cervical spine injury cannot be excluded by physical examination

The American Journal of Surgery ◽

10.1016/j.amjsurg.2008.07.040 ◽

2008 ◽

Vol 196 (6) ◽

pp. 857-863 ◽

Cited By ~ 21

Author(s):

Megan Steigelman ◽

Peter Lopez ◽

Daniel Dent ◽

John Myers ◽

Michael Corneille ◽

...

Keyword(s):

Cervical Spine ◽

Physical Examination ◽

Cervical Spine Injury ◽

Ct Scans ◽

Spine Injury ◽

Spine Ct ◽

Spine Mri

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Detection of Cervical Spine Injuries in Alert, Asymptomatic Geriatric Blunt Trauma Patients: Who Benefits from Radiologic Imaging?

The American Surgeon ◽

10.1177/000313480607200903 ◽

2006 ◽

Vol 72 (9) ◽

pp. 773-777 ◽

Cited By ~ 1

Author(s):

Adrian W. Ong ◽

Aurelio Rodriguez ◽

Robert Kelly ◽

Vicente Cortes ◽

Jack Protetch ◽

...

Keyword(s):

Computed Tomography ◽

Cervical Spine ◽

Blunt Trauma ◽

Cervical Spine Injury ◽

Motor Vehicle ◽

Spine Injury ◽

Trauma Patients ◽

Cervical Spine Injuries ◽

Spine Injuries ◽

Anatomic Locations

There are differing recommendations in the literature regarding cervical spine imaging in alert, asymptomatic geriatric patients. Previous studies also have not used computed tomography routinely. Given that cervical radiographs may miss up to 60 per cent of fractures, the incidence of cervical spine injuries in this population and its implications for clinical management are unclear. We conducted a retrospective study of blunt trauma patients 65 years and older who were alert, asymptomatic, hemodynamically stable, and had normal neurologic examinations. For inclusion, patients were required to have undergone computed tomography and plain radiographs. The presence and anatomic location of potentially distracting injuries or pain were recorded. Two hundred seventy-four patients were included, with a mean age of 76 ± 10 years. The main mechanisms of injury were falls (51%) and motor vehicle crashes (41%). Nine of 274 (3%) patients had cervical spine injuries. The presence of potentially distracting injuries above the clavicles was associated with cervical injury when compared with patients with distracting injuries in other anatomic locations or no distracting injuries (8/115 vs 1/159, P = 0.03). There was no association of cervical spine injury with age greater or less than 75 years or with mechanism of injury. The overall incidence of cervical spine injury in the alert, asymptomatic geriatric population is low. The risk is increased with a potentially distracting injury above the clavicles. Patients with distracting injuries in other anatomic locations or no distracting injuries may not need routine cervical imaging.

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Fracture Heat Map of The Facial Skull Demonstrates a Danger Zone of Concomitant Cervical Spine Injuries

10.21203/rs.3.rs-124119/v1 ◽

2020 ◽

Author(s):

Ákos Bicsák ◽

Robert Sarge ◽

Oliver Müller ◽

Stefan Hassfeld ◽

Lars Bonitz

Keyword(s):

Cervical Spine ◽

Cervical Spine Injury ◽

Soft Tissue Injury ◽

High Energy ◽

Maxillofacial Trauma ◽

Spine Injury ◽

Trauma Patients ◽

Maxillofacial Injury ◽

Cervical Spine Injuries ◽

Spine Injuries

Abstract Concomitant maxillofacial and cervical spine injuries occur in 0.8%-12% of the cases. We examined the relation of injury localization and the probability of cervical spine fracture.A retrospective study was conducted on patients that have been treated at Dortmund General Hospital for injuries both to the maxillofacial region and to the cervical spine between January 1st, 2007 and December 31th, 2017. Descriptive statistical methods were used to describe the correlation of cervical spine injuries with gender, age as well as maxillofacial injury localization.7708 patients were hospitalized with maxillofacial injury, among them 173 were identified with cervical spine injury. The average ages for both genders lie remarkably above the average of all maxillofacial trauma patients (36.2 y.o. in male and 50.9 y.o. in female). In the group of men, most injuries were found between the ages of 50 and 65. Whereas most injuries among women occurred after the age of 80. The relative ratio of cervical spine injuries (CSI) varies between 1.1% and 5.26% of the maxillofacial injuries (MFI), being highest in the soft tissue injury group, patients with forehead fractures (3.12%) and patients with panfacial fractures (2.52%). Further, nasal, Le Fort I and II, zygomatic complex and mandibular condyle fractures are often associated with CSI. Fractures next to the Frankfurt horizontal plane represent 87.7% of all MFI with concomitant CSI. Patients in critical age groups with a high-energy injury are more likely to suffer both, MFI and CSI injuries. Our findings help to avoid missing the diagnosis of cervical spine injury in maxillofacial trauma patients.

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Cervical Spine Clearance: A Review and Understanding of the Concepts

Journal of Nepal Medical Association ◽

10.31729/jnma.169 ◽

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

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Fracture heat map of the facial skull demonstrates a danger zone of concomitant cervical spine injuries

Scientific Reports ◽

10.1038/s41598-021-91543-2 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Ákos Bicsák ◽

Robert Sarge ◽

Oliver Müller ◽

Stefan Hassfeld ◽

Lars Bonitz

Keyword(s):

Cervical Spine ◽

Cervical Spine Injury ◽

Soft Tissue Injury ◽

High Energy ◽

Maxillofacial Trauma ◽

Spine Injury ◽

Trauma Patients ◽

Maxillofacial Injury ◽

Cervical Spine Injuries ◽

Spine Injuries

AbstractConcomitant maxillofacial and cervical spine injuries occur in 0.8–12% of the cases. We examined the relation of injury localization and the probability of cervical spine fracture. A retrospective study was conducted on patients that have been treated at Dortmund General Hospital for injuries both to the maxillofacial region and to the cervical spine between January 1st, 2007 and December 31th, 2017. Descriptive statistical methods were used to describe the correlation of cervical spine injuries with gender, age as well as maxillofacial injury localization. 7708 patients were hospitalized with maxillofacial injury, among them 173 were identified with cervical spine injury. The average ages for both genders lie remarkably above the average of all maxillofacial trauma patients (36.2 y.o. in male and 50.9 y.o. in female). In the group of men, most injuries were found between the ages of 50 and 65. Whereas most injuries among women occurred after the age of 80. The relative ratio of cervical spine injuries (CSI) varies between 1.1 and 5.26% of the maxillofacial injuries (MFI), being highest in the soft tissue injury group, patients with forehead fractures (3.12%) and patients with panfacial fractures (2.52%). Further, nasal, Le Fort I and II, zygomatic complex and mandibular condyle fractures are often associated with CSI. Fractures next to the Frankfurt horizontal plane represent 87.7% of all MFI with concomitant CSI. Patients in critical age groups with a high-energy injury are more likely to suffer both, MFI and CSI injuries. Our findings help to avoid missing the diagnosis of cervical spine injury in maxillofacial trauma patients.

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Subaxial cervical spine injuries

10.1093/med/9780199550647.003.012040 ◽

2011 ◽

Author(s):

Sergio Mendoza-Lattes ◽

Charles R. Clark

Keyword(s):

Cervical Spine ◽

Cervical Spine Injury ◽

Surgical Decompression ◽

Group Classification ◽

Spine Injury ◽

Study Group ◽

Cervical Spine Injuries ◽

Subaxial Cervical Spine ◽

Spine Injuries ◽

Conscious Patient

♦ The spine study group classification describes three families of fractures♦ Clinical examination can exclude a cervical spine injury in a non-distracted conscious patient without pain and neurological deficit♦ CT scan is the investigation of choice where fracture is suspected♦ Pure ligamentous injuries are rare♦ Priorities are immobilization and assessment, reduction of dislocations and then surgical decompression and stabilization.

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National Athletic Trainers' Association Position Statement: Acute Management of the Cervical Spine–Injured Athlete

Journal of Athletic Training ◽

10.4085/1062-6050-44.3.306 ◽

2009 ◽

Vol 44 (3) ◽

pp. 306-331 ◽

Cited By ~ 68

Author(s):

Erik E. Swartz ◽

Barry P. Boden ◽

Ronald W. Courson ◽

Laura C. Decoster ◽

Mary Beth Horodyski ◽

...

Keyword(s):

Health Care ◽

Cervical Spine ◽

Health Care Providers ◽

Cervical Spine Injury ◽

Athletic Trainers ◽

Current Evidence ◽

Spine Injury ◽

Care Providers ◽

Cervical Spine Injuries ◽

Spine Injuries

Abstract Objective: To provide certified athletic trainers, team physicians, emergency responders, and other health care professionals with recommendations on how to best manage a catastrophic cervical spine injury in the athlete. Background: The relative incidence of catastrophic cervical spine injury in sports is low compared with other injuries. However, cervical spine injuries necessitate delicate and precise management, often involving the combined efforts of a variety of health care providers. The outcome of a catastrophic cervical spine injury depends on the efficiency of this management process and the timeliness of transfer to a controlled environment for diagnosis and treatment. Recommendations: Recommendations are based on current evidence pertaining to prevention strategies to reduce the incidence of cervical spine injuries in sport; emergency planning and preparation to increase management efficiency; maintaining or creating neutral alignment in the cervical spine; accessing and maintaining the airway; stabilizing and transferring the athlete with a suspected cervical spine injury; managing the athlete participating in an equipment-laden sport, such as football, hockey, or lacrosse; and considerations in the emergency department.

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LOWER CERVICAL SPINE INJURY: DIAGNOSIS, CLASSIFICATION, TREATMENT

Hirurgiâ pozvonočnika ◽

10.14531/ss2005.3.8-24 ◽

2005 ◽

pp. 008-024

Author(s):

Edvard Aleksandrovich Ramikh

Keyword(s):

Cervical Spine ◽

Cervical Spine Injury ◽

Medical Rehabilitation ◽

Spine Injury ◽

Lower Cervical Spine ◽

Cervical Spine Injuries ◽

Subaxial Cervical Spine ◽

Spine Injuries ◽

Modern Classification ◽

Conservative And Surgical Treatment

During recent decades the spine specialists’ views on mechanism and nature of various injuries of the subaxial cervical spine have changed and become fuller. This predetermined the choice of pathogenetical therapy for each type of injury. In this respect the concept of treatment regimen for cervical spine injuries is presented from long-term experience of Trauma Clinics of Novosibirsk RITO and newer literature data. The problems of clinical semeiology, radiodiagnosis, lower cervical spine injury classifications are discussed. Issues of conservative and surgical treatment choice, medical rehabilitation of all types of subaxial cervical spine injuries in accordance with modern classification are considered in detail.

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Cervical Spine Injuries in Sports

The Duke Orthopaedic Journal ◽

10.5005/jp-journals-10017-1057 ◽

2015 ◽

Vol 5 (1) ◽

pp. 58-62

Author(s):

Daniel J Blizzard ◽

Michael A Gallizzi ◽

Lindsay T Kleeman ◽

Melissa M Erickson

Keyword(s):

Cervical Spine ◽

Cervical Spine Injury ◽

Spinal Cord Injuries ◽

Return To Play ◽

Atlantoaxial Instability ◽

Patient Specific ◽

Spine Injury ◽

Cervical Spine Injuries ◽

Early Return ◽

Spine Injuries

ABSTRACT Injuries to the cervical spine in athletes are rare but potentially devastating outcomes resulting from involvement in sports activities. New rules and regulations implemented by national sports organizations have helped to decrease the rate of cervical spine and spinal cord injuries sustained by athletes. A basic understanding of cervical spine anatomy, physical examination and spine precautions is necessary for any physi cian evaluating athletes on the field to determine if transfer to higher level of care is needed. It is particularly important to know the systematic protocol for spine immobilization, neuro logic exam and helmet removal in a patient with a suspected cervical spine injury. While cervical strain is the most common cervical spine injury, physicians should be familiar with the presentation for other injuries, such as Burner's syndrome (Stinger), cervical disk herniation, transient quadriplegia and cervical spine fractures or dislocations. Special consideration is needed when evaluating patients with Down syndrome as they are at higher risk for atlantoaxial instability. Determination of when an athlete can return to play is patient-specific with early return to play allowed only in a completely asymptomatic patient. Kleeman LT, Gallizzi MA, Blizzard DJ, Erickson MM. Cervical Spine Injuries in Sports. The Duke Orthop J 2015;5(1):5862.

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