Multicenter Prospective Validation of Prehospital Clinical Spinal Clearance Criteria

Domeier, Robert M.; Swor, Robert A.; Evans, Rawden W.; Hancock, J. F.; Fales, William; Krohmer, Jon R.; Frederiksen, Shirley M.; Rivera‐Rivera, Edgardo J.; Schork, M. Anthony

doi:10.1097/00005373-200210000-00021

Cited by 77 publications

(50 citation statements)

References 24 publications

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Section: Discussionmentioning

confidence: 99%

“…In one series, plain films detected 58% of fractures and 93% of subluxations or dislocations (94% of all abnormalities), while CT detected 90% of fractures and 54% of subluxations or dislocations (92% of all abnormalities) [136]. Therefore, CT may miss more ligamentous injuries and malalignments, and plain films more fractures [125,127,138], but the combination is especially powerful, consistently achieving 100% sensitivity in a number of studies [33,125,[127][128][129][136][137][138]. Furthermore, in addition to excellent sensitivity, the use of combined plain films and CT in 879 patients allowed 'major' (associated mechanical instability or neurological findings) and 'minor' injuries to be reliably and functionally distinguished [145].…”

Section: Computerised Tomographymentioning

confidence: 99%

“…2). These criteria have been incorporated in American College of Surgeons Advanced Trauma Life Support (ATLS) [30,67] and Eastern Association for the Surgery of Trauma (EAST) guidelines [68][69][70], and are supported by more than 20 clinical studies [33,. The very concept of a 'painless cervical fracture' in an alert patient is controversial [89], and may not be polytrauma .…”

Section: Clinical Evaluation Of the Cervical Spinementioning

confidence: 99%

“…Indeed, a significant proportion of actual injuries will be relatively stable and, if mobilised, are of little consequence. For example, only 8.6% of injuries missed by plain radiograph evaluation were ultimately unstable [32], and in one study of prehospital cervical spine immobilization, 13 ⁄ 15 (86.7%) of missed cervical spine injuries were subsequently regarded as stable [33].Among unconscious or obtunded polytrauma victims, in whom clinical assessment cannot exclude cervical injury, the actual performance of the various diagnostic imaging modalities assumes central importance. Furthermore, the care of the unconscious patient's cervical spine is often complicated by the fear of missing an isolated ligamentous injury with plain films or computerised tomography (CT), on the assumption that mechanical stability can only be confirmed by a normal clinical evaluation.…”

mentioning

confidence: 99%

“…These workers prospectively showed that these criteria were not affected by mechanism of injury, missing 3% and 6% of injuries in high and low risk groups, respectively [93]. These two studies prompted the production of practice guidelines for selectively immobilizing trauma victims during transfer [94,95], and clinical criteria identified 280 ⁄ 295 (94.9%) of cervical injuries [33]. Available evidence suggests that applying prehospital clinical criteria may raise suspicion of approximately 90% of spinal injuries but has little capacity to identify individual cases, and carries an unacceptable false negative rate of 10%.…”

mentioning

confidence: 99%

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Clearing the cervical spine in unconscious polytrauma victims, balancing risks and effective screening

Morris¹,

McCoy²

2004

Anaesthesia

106

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SummaryCervical spine injury occurs in 5-10% of cases of blunt polytrauma. A missed or delayed diagnosis of cervical spine injury may be associated with permanent neurological sequelae. However, there is no consensus about the ideal evaluation and management of the potentially injured cervical spine and, despite the publication of numerous clinical guidelines, this issue remains controversial. In addition, many studies are limited in their application to the obtunded or unconscious trauma victim. This review will provide the clinician managing unconscious trauma victims with an assessment of the actual performance of clinical examination and imaging modalities in detecting cervical spine and isolated ligamentous injury, a review of existing guidelines in light of the available evidence, relative risk estimates and a proposed management scheme. Cervical spine and associated spinal cord injury significantly affect the individual's functional capacity and quality of life, and carry significant implications for society. It was estimated in 1988 that a 27-year-old rendered tetraparetic would consume US$ 1 million for lifetime care and, with 721 tetraparetic individuals per million of the population, the total aggregate costs were an estimated US$ 5.6 billion per year [1]. In America, cervical, thoracic and lumbar vertebral fractures occur with an incidence of 50 000 per year [2], and cervical spine injury has an annual incidence of 5-10 000 cases per year [3,4]. More recent estimates suggest an incidence of 8-10 000 spinal cord injuries per year, of which 55% are cervical [5]. In the UK, there are approximately 1000 new cases of cervical cord injury each year [6]. Cervical spine injury complicates blunt polytrauma in 2-12% of cases [7][8][9]. However, several larger reviews that include 29 000 blunt trauma victims, and additional prospectively gathered data, demonstrate a generally lower incidence (2.0-5.2%) [10][11][12][13].The presence of a severe head injury increases the relative risk of a cervical spine injury, possibly by 8.5 times, and a focal neurological deficit by 58 times [14]. A Glasgow Coma Scale (GCS) score of < 8 is associated with a 50% increase in the incidence of cervical spine injury to 7.8% [15]. Similarly, Demetriades et al.[16] have shown that although the incidence of cervical spine injury in trauma victims with a GCS score of 13-15 was only 1.4%; this increased to 10.2% if GCS was < 8. 'Primary' cervical spine injury may be associated with head injury in 24-35% of cases [10,[16][17][18][19][20], and among polytrauma victims requiring cervical spine stabilization surgery, only 74% suffered an isolated injury [21]. The prognosis in patients suffering both head and cervical injury is typically poor, with approximately 25% being discharged to a dedicated nursing facility with little prospect of recovery [22]. Traumatic brain injury has a UK incidence of 100 per 100 000 population [23], typically among young, working age males, and therefore the combined consequences of brain and spine injury both ...

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Section: Discussionmentioning

confidence: 99%