Validity of a Set of Clinical Criteria to Rule Out Injury to the Cervical Spine in Patients with Blunt Trauma

Hoffman, Jerome R.; Mower, William R.; Wolfson, Allan B.; Todd, Knox H.; Zucker, Michael I.

doi:10.1056/nejm200007133430203

Cited by 1,140 publications

(570 citation statements)

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“…In fact, this study showed an association of 100% between cervical spine injuries and head injury. Moreover, the literature reports an average incidence of 50% of injuries to other organs associated with cervical spine injuries 12,16 and in the present study we observed an association between cervical spine injury and injuries to other organs in 100% of cases. We also found that the severity of the victims (as measured by ISS, and TRISS RTS) was higher among those who had cervical lesions at CT.…”

Section: Results Results Results Resultssupporting

confidence: 73%

“…Hence the great importance of early and accurate diagnosis of lesions of the spine and cervical spinal cord in victims of blunt trauma 11,12 . Several diagnostic methods are used to identify such lesions, from physical examination to more sophisticated imaging tests, such as computed tomography (CT) and magnetic resonance imaging (MRI) 5,8,12 , CT being the most used feature, allowing to Pinheiro Pinheiro Pinheiro Pinheiro Pinheiro Diagnostic value of tomography of the cervical spine in victims of blunt trauma characterize the presence or absence of injury to the cervical spinal column in most cases 11,12 .…”

Section: Results Resultsmentioning

confidence: 99%

“…Several diagnostic methods are used to identify such lesions, from physical examination to more sophisticated imaging tests, such as computed tomography (CT) and magnetic resonance imaging (MRI) 5,8,12 , CT being the most used feature, allowing to Pinheiro Pinheiro Pinheiro Pinheiro Pinheiro Diagnostic value of tomography of the cervical spine in victims of blunt trauma characterize the presence or absence of injury to the cervical spinal column in most cases 11,12 . Like all diagnostic methods, CT has limitations, has its costs and its indication criteria are not strictly accurate, possibly leading the physician to indicate it unnecessarily or fail to indicate it, hampering the accurate diagnosis of an important lesion 9 .…”

Section: Introduction Introduction Introduction Introductionmentioning

confidence: 99%

“…In addition, it causes large health system expenditures, both with prolonged hospitalization and treatment, which usually lasts for years 5,8 . Besides medical treatment, social and economic costs resulting from cervical spinal cord injuries are enormous, as up to 85% of victims who resist the first 24 hours after trauma survive for more than 10 years 3 and, being in the productive age group, suffer large reduction in productivity due to prolonged absences from work, early retirement and unemployment 2,5,[8][9][10] .Hence the great importance of early and accurate diagnosis of lesions of the spine and cervical spinal cord in victims of blunt trauma 11,12 . Several diagnostic methods are used to identify such lesions, from physical examination to more sophisticated imaging tests, such as computed tomography (CT) and magnetic resonance imaging (MRI) 5,8,12 , CT being the most used feature, allowing to Pinheiro Pinheiro Pinheiro Pinheiro Pinheiro Diagnostic value of tomography of the cervical spine in victims of blunt trauma characterize the presence or absence of injury to the cervical spinal column in most cases 11,12 .…”

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confidence: 99%

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Valor diagnóstico da tomografia de coluna cervical em vítimas de trauma contuso

Pinheiro¹,

Fontes²,

Shimazaki³

et al. 2011

Rev. Col. Bras. Cir.

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ABSTRACT ABSTRACT ABSTRACTObjective Objective Objective Objective Objective: to assess the value of computed tomography in the diagnosis of cervical spine and spinal cord injuries in victims of blunt trauma. MethodsMethods Methods Methods Methods: we reviewed the charts of blunt trauma victims from January 2006 to December 2008. We analyzed the following data: epidemiology, mechanism of trauma, transportation of victims to the hospital, intra-hospital care, indication criteria for CT, diagnosis, treatment and evolution of the victims. The victims were divided into two groups: Group I -without cervical spine injury, Group II -with cervical spine injury. Results Results ResultsResults Results: we gathered medical records from 3,101 victims. Computed tomography was performed in 1572 (51%) patients, with male predominance (79%) and mean age of 38.53 years in Group I and 37.60 years in Group II. The distribution of trauma mechanisms was similar in both groups. Lesions found included: 53 fractures, eight vertebral listeses and eight spinal cord injuries. Sequelae included: paraplegia in three cases, quadriplegia in eight and brain injury in five. There were seven deaths in Group II and 240 in Group I. The average length of hospital stay was 11 days for Group I and 26.2 days for Group II. Conclusion Conclusion Conclusion Conclusion Conclusion. A CT scan of the cervical spine in victims of blunt trauma was effective in identifying lesions of the cervical spine and spinal cord injuries. Thus, despite the cost of neck CT and the low incidence of lesions identified by it, its indication based on the usual criteria seems justified. T raumatic injuries account for more than 3.2 million deaths and more than 312 million injured annually worldwide [1][2][3] . In the United States of America (USA) more than 60 million people, mostly aged up to 40 years, are victims of traumatic injuries each year. For every death due to trauma there are 19 hospital admissions, 233 medical consultations and 450 emergencies consultations 1,3,4 . Also in the U.S., 7,800 people annually (32 per million population) suffer spinal cord injuries due to trauma to the spine, the cervical spine representing nearly half (48.7%) of these victims 5 . In Europe,trauma is also the leading cause of death in people up to 40 years of age 3,6 . Thus, trauma has been an increasingly frequent focus of studies and investment in both developed and developing countries 7 .Traumatic injury of the cervical spinal cord is an extremely worrying problem in trauma patient care throughout the world due to the high risk of death and severe sequelae that result in serious permanent limitations, both physical, social and professional. In addition, it causes large health system expenditures, both with prolonged hospitalization and treatment, which usually lasts for years 5,8 . Besides medical treatment, social and economic costs resulting from cervical spinal cord injuries are enormous, as up to 85% of victims who resist the first 24 hours after trauma survive fo...

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Section: Results Results Results Resultssupporting

confidence: 73%

Section: Results Resultsmentioning

confidence: 99%

Section: Introduction Introduction Introduction Introductionmentioning

confidence: 99%

mentioning

confidence: 99%

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Valor diagnóstico da tomografia de coluna cervical em vítimas de trauma contuso

Pinheiro¹,

Fontes²,

Shimazaki³

et al. 2011

Rev. Col. Bras. Cir.

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“…Many of these studies were done in the obtunded or altered patient; few address the dilemma of cervical spine clearance in the awake and alert patient with ongoing cervical tenderness [6,7]. The EAST and NEXUS guidelines recommend flexion extension films for the awake and alert patient with continued cervical tenderness after negative plain films or CT scans [2,19,20]. The algorithms mandate that the flexion extension films be adequate and negative however those terms are not specifically defined.…”

Section: Discussionmentioning

confidence: 99%

Flexion and extension radiographic evaluation for the clearance of potential cervical spine injures in trauma patients

et al. 2013

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Background Flexion and extension radiographs are often used in the setting of trauma to clear a cervical spine injury. The utility of such tests, however, remains to be determined. We hypothesized that in patients who underwent a negative computed tomography (CT) cervical spine scan, flexion and extension radiographs did not yield useful additional information. Methods We conducted a retrospective chart review of all patients admitted to a Level I trauma center who had a negative CT scan of the cervical spine and a subsequent cervical flexion-extension study for evaluation of potential cervical spine injury. All flexion-extension films were independently reviewed to determine adequacy as defined by C7/T1 visualization and 30°of change in the angle from flexion to extension. The independent reviews were compared to formal radiology readings and the influence of the flexion-extension studies on clinical decision making was also reviewed. Results One thousand patients met inclusion criteria for the study. Review of the flexion-extension radiographs revealed that 80 % of the films either did not adequately demonstrate the C7/T1 junction or had less than 30°range of motion. There was one missed injury that was also missed on magnetic resonance imaging. Results of the flexion-extension views had minimal effects on clinical decision making. Conclusion Adequate flexion extension films are difficult to obtain and are minimally helpful for clearance of the cervical spine in awake and alert trauma patients.

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