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The Risk of Cervical Spine Injuries among Submersion Patients in River  

Kim, Suk Hwan (Department of Emergency medicine, college of medicine, Catholic University)
Choi, Kyung Ho (Department of Emergency medicine, college of medicine, Catholic University)
Choi, Se Min (Department of Emergency medicine, college of medicine, Catholic University)
Oh, Young Min (Department of Emergency medicine, college of medicine, Catholic University)
Seo, Jin Sook (Department of Emergency medicine, college of medicine, Catholic University)
Lee, Mi Jin (Department of Emergency medicine, college of medicine, Catholic University)
Park, Kyu Nam (Department of Emergency medicine, college of medicine, Catholic University)
Lee, Won Jae (Department of Emergency medicine, college of medicine, Catholic University)
Publication Information
Journal of Trauma and Injury / v.19, no.1, 2006 , pp. 47-53 More about this Journal
Abstract
Purpose: Recently, the American Heart Association recommended that routine cervical spine protection in submerged patients was not necessary, except in high-energy injury situations. However, until now, this recommendation has few supportive studies and literatures. This retrospective study was performed to demonstrate the risk of cervical spine injury in patients who had been submerged in a river. Methods: Seventy-nine submerged patients who visited St. Mary's Hospital between January 2000 and December 2005 were included in this retrospective study. We investigated and analyzed the victim's age, sex, activity on submersion, mental status and level of severity at admission, prognosis at discharge, associated injuries, and risk group by using the medical records and cervical spine lateral images. According to the activity on submersion, victims were classified into three groups: high risk, low risk, and unknown risk. The reports of radiologic studies were classified into unstable fracture, stable fracture, sprain, degenerative change, and normal. Results: The patients' mean age was 36.8 yrs, and 54% were males. Of the 79 patients, adult and adolescent populations (80%) were dominant. Jumping from a high bridge (48%) was the most common activity on submersion and accounted for 52% of the high-risk group. The Glasgow coma scale at admission and the cerebral performance scale at discharge showed bimodal patterns. The results of the radiologic studies showed one stable fracture, one suspicious stable fracture, and 18 sprains. The incidence of cervical spine fracture in submerged patients was 2.5% in our study. The incidence of cervical spine injury was higher in the high-risk group than it was in the low-risk group, especially in the jumping-from-high-bridge subgroup; however this observation was not statistically significant. No other factors had any significant effect on the incidence of cervical spine injury. Conclusion: Our study showed that even submerged patients in the high risk group had a low incidence of cervical spine fracture and that the prognosis of a patient did not seem to be influenced by the cervical spine fracture itself.
Keywords
Submersion; Cervical Vertebrae; Fracture; Risk factors;
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  • Reference
1 Denis F. Spinal instability as defined by the threecolumn spine concept in acute spinal trauma. Clin Orthop Relat Res. 1984;189:65-76
2 Demetriades D, Charalambides K, Chahwan S, Hanpeter D, Alo K, Velmahos G, et al. Nonskeletal cervical spine injuries: epidemiology and diagnostic Pitfalls. Trauma 2000;48:724-7   DOI
3 Crim JR, Moore K, Brodke D. Clearance of the cervical spine in multitrauma patients: the role of advanced imaging. Semin Ultrasound CT MR 2001;22:283-305   DOI   ScienceOn
4 Watson RS, Cummings P, Quan L, Bratton S, Weiss NS. Cervical spine injuries among submersion victims. J Trauma 2001;51:658-62   DOI   ScienceOn
5 Hwang V, Shofer FS, Durbin DR, Baren JM. Prevalence of traumatic injuries in drowning and near drowning in children and adolescents. Arch Pediatr Adolesc Med. 2003;157:50-3   DOI   ScienceOn
6 Mower WR, Hoffman J. Comparison of the Canadian C-Spine rule and NEXUS decision instrument in evaluating blunt trauma patients for cervical spine injury. Ann Emerg Med 2004;43:515-7   DOI   ScienceOn
7 Knopp R. Comparing NEXUS and Canadian CSpine decision rules for determining the need for cervical spine radiography. Ann Emerg Med 2004;43:518-20   DOI   ScienceOn
8 Dickinson G, Stiell IG, Schull M, Brison R, Clement CM, Vandemheen KL, et al. Retrospective application of the NEXUS low-risk criteria for cervical spine radiography in Canadian emergency departments. Ann Emerg Med 2004;43:507-14   DOI   ScienceOn
9 Simonsen J. Injuries sustained from high-velocity impact with water after jumps from high bridges. a preliminary report of 10 cases. Am J Forensic Med Pathol 1983;4:139-42   DOI
10 Bailes JE, Herman JM, Quigley MR, Cerullo LJ, Meyer PR Jr. Diving injuries of the cervical spine. Surg Neurol 1990;34:155-8   DOI   ScienceOn
11 Parnes N, Marmor M, Gold A, Steinberg EL. Imaging of acute cervical spine trauma. Harefuah 2005;144:211-5, 229
12 Denis F. The three column spine and its significance in the classification of acute thoracolumbar spinal injuries. Spine 1983;8:817-31   DOI   ScienceOn
13 Wyer P. The Canadian C-Spine Rule more accurately identified cervical-spine injury in trauma than the NEXUS Low-Risk Criteria. ACP J Club 2004;141:24