scholarly journals Use of diagnostic imaging in the emergency department for cervical spine injuries in Kingston, Ontario

CJEM ◽  
2014 ◽  
Vol 16 (01) ◽  
pp. 25-33
Author(s):  
William Pickett ◽  
Atif Kukaswadia ◽  
Wendy Thompson ◽  
Mylene Frechette ◽  
Steven McFaull ◽  
...  
Keyword(s):  
Cervical Spine ◽  
Diagnostic Imaging ◽  
Clinical Decision ◽  
Neck Injury ◽  
Spine Injury ◽  
Cervical Spine Injuries ◽  
Spine Injuries ◽  
Cervical Spine Radiography ◽  
Clinically Significant ◽  
Over Time

ABSTRACTObjectives:This study assessed the use and clinical yield of diagnostic imaging (radiography, computed tomography, and medical resonance imaging) ordered to assist in the diagnosis of acute neck injuries presenting to emergency departments (EDs) in Kingston, Ontario, from 2002–2003 to 2009–2010.Methods:Acute neck injury cases were identified using records from the Kingston sites of the Canadian National Ambulatory Care Reporting System. Use of radiography was analyzed over time and related to proportions of cases diagnosed with clinically significant cervical spine injuries.Results:A total of 4,712 neck injury cases were identified. Proportions of cases referred for diagnostic imaging to the neck varied significantly over time, from 30.4% in 2002–2003 to 37.6% in 2009–2010 (ptrend= 0.02). The percentage of total cases that were positive for clinically significant cervical spine injury (“clinical yield”) also varied from a low of 5.8% in 2005–2006 to 9.2% in 2008–2009 (ptrend= 0.04), although the clinical yield of neck-imaged cases did not increase across the study years (ptrend= 0.23). Increased clinical yield was not observed in association with higher neck imaging rates whether that yield was expressed as a percentage of total cases positive for clinically significant injury (p= 0.29) or as a percentage of neck-imaged cases that were positive (p= 0.77).Conclusions:We observed increases in the use of diagnostic images over time, reflecting a need to reinforce an existing clinical decision rule for cervical spine radiography. Temporal increases in the clinical yield for total cases may suggest a changing case mix or more judicious use of advanced types of diagnostic imaging.

Neck Injury

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.

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

CJEM ◽  
2014 ◽  
Vol 16 (02) ◽  
pp. 131-135 ◽  
Author(s):  
Hendrik P. Van Zyl ◽  
James Bilbey ◽  
Alan Vukusic ◽  
Todd Ring ◽  
Jennifer Oakes ◽  
...  
Keyword(s):  
Cervical Spine ◽  
Cervical Spine Injury ◽  
Clinical Skills ◽  
Ct Scans ◽  
Spine Injury ◽  
Emergency Physicians ◽  
Cervical Spine Injuries ◽  
Spine Ct ◽  
Spine Injuries ◽  
Rule Out

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.

Cervical spine injuries

2019 ◽  
pp. 789-800
Author(s):  
Calan Mathieson ◽  
Chris Barrett ◽  
Likhith Alakandy
Keyword(s):  
Cervical Spine ◽  
Classification Systems ◽  
Neurological Injury ◽  
Spine Injury ◽  
Spine Fractures ◽  
Cervical Spine Injuries ◽  
Heterogenous Group ◽  
Spine Injuries ◽  
Spine Surgeon ◽  
Cervical Spine Fractures

The management of cervical spine fractures is a complex and fascinating topic. A multitude of descriptive terminologies and classification systems have been developed over the years in an attempt to better understand this heterogenous group of patients. Despite this however, there is often little consensus with regards to the best way to manage this population. This chapter will predominantly discuss the decision-making process involved in the management of cervical spine fractures. The goal of the spine surgeon in managing patients with acute cervical spine injury is to prevent secondary neurological injury, deformity, and pain by re-establishing stability if necessary. Assessing how to achieve this goal can be very challenging. The surgeon will be faced with many questions. Which patients should undergo surgical intervention? Which operation will best stabilize the spine? Which patients should be treated with a collar or a halo vest? Does the injury require reduction with traction initially? There are also questions of timing. When should the surgeon plan the proposed procedure?

Diagnostic imaging of cervical spine injuries following blunt trauma: A review of the literature and practical guideline

Injury ◽  
2009 ◽  
Vol 40 (8) ◽  
pp. 795-800 ◽  
Author(s):  
T.P. Saltzherr ◽  
P.H.P. Fung Kon Jin ◽  
L.F.M. Beenen ◽  
W.P. Vandertop ◽  
J.C. Goslings
Keyword(s):  
Cervical Spine ◽  
Diagnostic Imaging ◽  
Blunt Trauma ◽  
Review Of The Literature ◽  
Cervical Spine Injuries ◽  
Practical Guideline ◽  
Spine Injuries

scholarly journals A study on functional outcome following surgical fixation for lower spine injuries

2021 ◽  
Author(s):  
M. Sivakumar ◽  
M. Ganesh Kumar
Keyword(s):  
Cervical Spine ◽  
Functional Outcome ◽  
Tamil Nadu ◽  
Spinal Injury ◽  
Spine Injury ◽  
Trauma Patients ◽  
Cervical Spine Injuries ◽  
Spine Injuries ◽  
Disc Bulge ◽  
Surgical Fixation

<p class="abstract"><strong>Background:</strong> Cervical spine injuries are one of the common causes of serious morbidity mortality following trauma. 6% of trauma patients have spine injuries of which &gt;50% is contributed by a cervical spine injury. The aim of the study was to determine the functional outcome following surgical fixation for sub-axial cervical spine.</p><p class="abstract"><strong>Methods:</strong> this prospective study involving 17 patients who were all admitted with sub-axial cervical spine injuries and amenable to intervention in our department of orthopedics and traumatology, government Theni medical college, Tamil Nadu, India in the year 2019-2020. Duration of 6 months from December 2019 to may 2020.<strong></strong></p><p class="abstract"><strong>Results:</strong> Most of the injuries presented within 24 hours of injury. Most of the patients presented with an incomplete neurological deficit. C5-C6 subluxation with disc bulge was the most common spinal injury. 5 patients were operated on more than 2 levels. The rest of the patients were operated on at 2 levels.</p><p class="abstract"><strong>Conclusions:</strong> We consider that the anterior decompression and fusion with a locking compression plate is a viable procedure in sub-axial cervical spine injuries.</p>

scholarly journals Currently available classification systems for lower cervical spine injuries. Part 1. Overview of the most popular scales and classifications

2019 ◽  
Vol 21 (1) ◽  
pp. 90-102 ◽  
Author(s):  
A. A. Grin ◽  
I. S. Lvov ◽  
S. L. Arakelyan ◽  
A. E. Talypov ◽  
A. Yu. Kordonsky ◽  
...  
Keyword(s):  
Cervical Spine ◽  
Classification System ◽  
Injury Severity ◽  
Scoring Systems ◽  
Classification Systems ◽  
Spine Injury ◽  
Lower Cervical Spine ◽  
Cervical Spine Injuries ◽  
Advantages And Disadvantages ◽  
Spine Injuries

This article provides a detailed illustrated description of currently available classification and scoring systems for lower cervical spine injuries (including Allen–Fergusson, J. Harris et al., C. Argenson et al., and AOSpine classifications, Subaxial Injury Classification System and Cervical Spine Injury Severity Score). The present review primarily aims to discuss the advantages and disadvantages of each classification system. 

Delay in clearing cervical spine injuries in obtunded trauma patients and its implications

Trauma ◽  
2017 ◽  
Vol 20 (4) ◽  
pp. 273-280
Author(s):  
Kamaljit K Parmar ◽  
Kwok M Ho ◽  
Timothy Bowles
Keyword(s):  
Computed Tomography ◽  
Cervical Spine ◽  
Weekend Effect ◽  
Spine Injury ◽  
Trauma Patients ◽  
Prospective Audit ◽  
Cervical Spine Injuries ◽  
Increased Risk ◽  
Spine Injuries ◽  
Injury Status

Introduction Prompt recognition of cervical spine injuries may limit spinal cord damage. This prospective audit assessed the time needed to formally confirm the status of cervical spine using a computed tomography scan, the reasons for any delays, and the subsequent outcomes. Methodology Prospective audit analysed the data of 100 consecutive unconscious trauma patients, admitted over a seven-month period, to ascertain whether there was a ‘weekend’ effect in validating the cervical spine status radiologically, and whether the delays were associated with an increased risk of pneumonia and other complications. The sensitivity and specificity of using bony fractures and mal-alignment on the computed tomography scans to diagnose cervical spine injuries were calculated. Results Significant radiological evidence of cervical spine injuries occurred in 37 patients (37%). A delay in >48 h to ascertain the cervical spine status occurred in 36 patients, mostly due to logistical (58%) reasons, and this was associated with an increased risk of pneumonia requiring antibiotics (p < 0.001). A ‘weekend’ effect and presence of cervical spine injuries were not significantly related to the time to confirm the cervical spine injury status radiologically. The specificity (98%) of using bony fractures and mal-alignment on the computed tomography to diagnose cervical spine injuries was high, but its sensitivity (83.8%) was only modest. Conclusions A delay to confirm the cervical spine injury status was common and associated with an increased risk of pneumonia in unconscious trauma patients, particularly among those who did not sustain any cervical spine injuries. The low sensitivity of computed tomography to exclude non-bony cervical spine injuries suggests that selective early use of magnetic resonance imaging scans for high-risk unconscious trauma patients may improve patient outcomes.

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

2006 ◽  
Vol 72 (9) ◽  
pp. 773-777 ◽  
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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