Risk Factors for Cervical Spine Injury in an Obtunded Blunt Trauma Patient

2021 ◽  
Vol 104 (12) ◽  
pp. 1902-1907
Keyword(s):  
Risk Factors ◽  
Cervical Spine ◽  
Trauma Patient ◽  
Blunt Trauma ◽  
Thoracic Spine ◽  
Cervical Spine Injury ◽  
Spine Injury ◽  
Trauma Patients ◽  
Blunt Trauma Patient ◽  
Thoracic Spine Fracture

Background: In Thailand, many hospitals cannot send every obtunded blunt trauma patient for cervical spine CT scan because of the socioeconomic status. Knowing about the risk factors for cervical spine injury in an obtunded blunt trauma patient would help the clinician monitor for cervical spine injury. Objective: To identify the risk factors of cervical spine injury in an obtunded blunt trauma patient. Materials and Methods: The present study evaluated 400 obtunded blunt trauma patients with a GCS of less than 15, in the trauma center of Srinagarind Hospital between January 2015 and December 2019. The patients were chosen from the patient’s registry for the present retrospective cross-sectional study. A univariate analysis was fulfilled with potential risk factors such as age, gender, mechanism of injury, GCS, associated injury, and intracranial lesion. Then, multivariate analysis was used to identify the risk factors of cervical spine injury in obtunded blunt trauma patients. Results: Four hundred patients were included in the present study. Eighty-eight (22%, 95% CI 18.04 to 26.38) had a cervical spine injury. The mean age was 40.04 years, 73% were males with a male to female ratio of 2.7 to 1. For the mechanisms of injury, 66% of injuries resulted from motorcycle accidents, 15% from car accidents, and 14% from falls. From univariate analysis, age older than 60 years had significant higher odds of cervical spine injury than age younger than 60 years (OR 1.93, 95% CI 1.05 to 3.54). Thoracic spine fracture had significant higher odds of cervical spine injury than other associate injuries (OR 6.2, 95% CI 1.45 to 26.5). From multivariate analysis, age older than 60 years had significant higher odds of cervical spine injury than age younger than 60 years (aOR 1.99, 95% CI 1.07 to 3.68). Thoracic spine fracture had a significantly higher odds of cervical spine injury than the other associated injuries (aOR 6.4, 95% CI 1.48 to 27.63). In patients age older than 60 years, 42% of cervical spine injuries occurred from fall. Conclusion: From the present study, age older than 60 years and thoracic spine fracture are the significant risk factors of cervical spine injury in obtunded blunt trauma patients. Keywords: Cervical spine injury; Risk factors; Obtunded blunt trauma patient

Prehospital Factors Associated With Cervical Spine Injury in Pediatric Blunt Trauma Patients

2020 ◽  
Author(s):  
Lorin R. Browne ◽  
Fahd A. Ahmad ◽  
Hamilton Schwartz ◽  
Michael Wallendorf ◽  
Nathan Kuppermann ◽  
...  
Keyword(s):  
Cervical Spine ◽  
Blunt Trauma ◽  
Cervical Spine Injury ◽  
Spine Injury ◽  
Trauma Patients ◽  
Factors Associated

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.

scholarly journals A systematic review of the need for MRI for the clearance of cervical spine injury in obtunded blunt trauma patients after normal cervical spine CT

2014 ◽  
Vol 7 (4) ◽  
pp. 251 ◽  
Author(s):  
DavidC Evans ◽  
Ahmad Moukalled ◽  
Elizabeth Yu ◽  
DavidB Tulman ◽  
StanislawPA Stawicki ◽  
...  
Keyword(s):  
Systematic Review ◽  
Cervical Spine ◽  
Blunt Trauma ◽  
Cervical Spine Injury ◽  
Spine Injury ◽  
Trauma Patients ◽  
Spine Ct

64-Slice CT compared to MRI to clear cervical spine injury in high-risk GCS < 14 blunt trauma patients admitted to the ICU

Trauma ◽  
2017 ◽  
Vol 20 (1) ◽  
pp. 38-45
Author(s):  
Jessica McCallum ◽  
Patrick McLaughlin ◽  
Morad Hameed ◽  
Hussein D Kanji
Keyword(s):  
Cervical Spine ◽  
High Risk ◽  
Ct Scan ◽  
Blunt Trauma ◽  
Cervical Spine Injury ◽  
Spine Injury ◽  
Trauma Patients ◽  
Positive Finding ◽  
Clinically Significant ◽  
Significant Injury

Objective Clearance of cervical spine injury including ligamentous injury is of paramount importance as results of missed injury may have serious consequences. In obtunded patients, cervical spine clearance is challenging. This study sought to determine whether a negative 64-slice CT scan alone is sufficient to clear cervical spine injury. Patients and methods All consecutive blunt trauma patients admitted to a regional (level 1) trauma center from 1 April 2008 to 31 March 2012 were screened for inclusion in this study. High-risk, GCS < 14, blunt trauma patients were included if they were admitted to the intensive care unit, had a negative 64-slice CT, and MRI of diagnostic quality. GCS was measured at the time of CT scan. Patients with a positive finding on CT scan were excluded. All images were re-interpreted by a trauma radiologist blinded to clinical outcome. Details of missed injuries and clinical impact were reported. The primary outcome was missed clinically significant injury, defined as any injury requiring an additional intervention including continued immobilization or surgery. Results There were 5891 blunt trauma patients admitted to the ICU, 44 of whom met inclusion criteria. Patients had a median injury severity score of 35 and MRI three (2–9) days after CT. Eight of 44 (18%) patients had a positive finding on MRI and five of the findings were clinically insignificant. Three patients (7%) with focal neurologic findings on clinical exam had missed injuries requiring immobilization with a collar. Two of these patients had spine disease, which may have increased their injury risk. Conclusions In high-risk obtunded blunt trauma patients admitted to the ICU, a negative 64-slice CT scan alone is insufficient to clear clinically significant cervical spine injury, with a missed clinically significant injury rate of 7%. When considered with symmetric motor function, a negative 64-slice CT scan may be sufficient. A prospective study is required to confirm these findings.

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