Diagnosis of Cervical Spine Injury in Motor Vehicle Crash Victims

Macdonald, Rachel; Schwartz, Michael L.; D, Mirich; Sharkey, Philip; Nelson, William R.

doi:10.1097/00005373-199004000-00004

Cited by 51 publications

(42 citation statements)

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“…As being reported in literature, a cross-table lateral view alone is associated with delayed diagnosis in 15-20% [6,10,11]. In our study six skeletal injuries were missed because only a lateral view of the cervical spine was performed during initial examination.…”

Section: Discussionmentioning

confidence: 46%

“…Additional radiological examinations may be neces- sary, but the least diagnostic workup should include this series. Several studies have reported a sensitivity rate of nearly 100% using the standard three-view cervical spine series, if complete and adequate visualization of the C-spine is attainable [8,10,13].…”

Section: Discussionmentioning

confidence: 99%

“…Inadequate imaging as well as incomplete sets of radiographs are commonly responsible for delays in diagnosis in these patients. However, early recognition and management of cervical spine injuries is necessary, since false or delayed diagnosis might lead to tragic consequences, ranging from neurological deficits to complete tetraplegia [8,10,11]. A generally approved guideline to assess the cervical spine in polytrauma patients might significantly reduce delays in diagnosis, but a comprehensive protocol for evaluating the cervical spine has not been uniformly accepted or performed by clinicians, and the approach to cervical spine clearance in the trauma room still varies from center to center [1,[7][8][9]14].…”

Section: Introductionmentioning

confidence: 99%

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Clearing the Cervical Spine in Polytrauma Patients: Current Standards in Diagnostic Algorithm

Platzer

Thalhammer²,

Jaindl³

et al. 2006

Eur J Trauma

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Introduction: Clearing the cervical spine in polytrauma patients still presents a challenge for the trauma team. The risk of an overlooked cervical spine injury is substantial since these patients show painful and lifethreatening injuries to one or more organ systems so that clinical examination is usually not reliable. A generally approved guideline to assess the cervical spine in polytrauma patients might significantly reduce delays in diagnosis, but a consistent protocol for evaluating the cervical spine has not been uniformly accepted or performed by clinicians. The aim of this study was to assess the safety and efficacy of the diagnostic algorithm at this trauma center and to propose a possible consensus of the optimal method for clearing the cervical spine in polytrauma patients. Materials and Methods:This study retrospectively analyzed the clinical records of all polytrauma patients with cervical spine injuries (n = 118) who were admitted to this level-I trauma center between 1980 and 2004. All patients were assessed following the trauma algorithm of our unit (modified by Nast-Kolb). Standard radiological evaluation of the cervical spine consisted of a single lateral view or a three-view cervical spine series. Further radiological examinations (functional flexion/extension views, oblique views, CT-scan, MRI) were performed by clinical suspicion of an injury or when indicated by the standard radiographs. Results: Correct diagnosis was made in 107 patients (91%) during primary trauma evaluation, whereas in 11 patients (9%) our approach to clear the cervical spine failed to detect significant cervical spine injuries: In six cases skeletal injuries were missed because only a lateral view of the cervical spine was performed during primary trauma evaluation and in one case because a three-view cervical spine series did not show the extent of the injury. In four cases discoligamentous injuries were missed despite complete sets of standard radiographs and a CT-scan, but missing functional flexion/extension views. Conclusion: For assessment of the cervical spine in poly-trauma patients we recommend a three-view trauma series as minimum to clear the cervical spine and the more liberal use of CT-scan as standard diagnostic tool in a specific subset of patients with clinically suspected cervical spine injuries and significant trauma history. In those patients also, passive functional flexion/extension views should be considered as obligate in later stages of diagnostic algorithm.

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Section: Discussionmentioning

confidence: 46%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Clearing the Cervical Spine in Polytrauma Patients: Current Standards in Diagnostic Algorithm

Platzer

Thalhammer²,

Jaindl³

et al. 2006

Eur J Trauma

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show abstract

“…11 If a patient presents with a cervical spine injury the clinician must have a high index of suspicion that there may be injuries to the thoraco-lumbar spine and radiographs are indicated if there is any suggestion of injury such as local tenderness or bruising over the spine.…”

Section: Radiological Assessmentmentioning

confidence: 99%

(ii) Thoraco-lumbar fractures

Pasapula

Wilson-MacDonald

2004

Current Orthopaedics

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“…Several studies have reviewed the issue of missed injuries in the trauma population, and the reported incidence of significant missed spinal injuries is low, with an exact figure dependent on the study population. [1][2][3][4][5] However, most of these studies are authored by general trauma surgeons and/or radiologists, with many of the recent reports lacking sufficient follow-up.…”

mentioning

confidence: 99%