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Predictive Factors for MDCT as a Primary Survey in Traumatic Cervical Spine Injury  

Pak, Guen-E. (Department of Emergency Medicine, College of Medicine, Korea University)
Han, Chul (Department of Emergency Medicine, College of Medicine, Korea University)
Cho, Young-Duck (Department of Emergency Medicine, College of Medicine, Korea University)
Kim, Jung-Youn (Department of Emergency Medicine, College of Medicine, Korea University)
Yoon, Young-Hoon (Department of Emergency Medicine, College of Medicine, Korea University)
Lee, Sung-Woo (Department of Emergency Medicine, College of Medicine, Korea University)
Moon, Sung-Woo (Department of Emergency Medicine, College of Medicine, Korea University)
Choi, Sung-Hyuk (Department of Emergency Medicine, College of Medicine, Korea University)
Publication Information
Journal of Trauma and Injury / v.24, no.1, 2011 , pp. 18-24 More about this Journal
Abstract
Purpose: Missing cervical pathology after injury may lead to disability and influence long-term survival. Controversies continue to evolve concerning the initial screening methods used to predict cervical spine injury. Through a retrospective chart review, we attempted to analyze and propose factors predictive of cervical trauma. Methods: Of all the patients who had visited the Emergency Department of Korea University, from January 2009 to December 2009, a retrospective review of the clinical records of the 217 patients who had undergone cervical spine computed tomography was done. We investigated whether we could predict the need for cervical spine computed tomography shortly after presentation in trauma patients by comparing the group with fractures and group without fractures and by finding risk factors showing significant differences between the two groups that might be used as guides in decision making. Results: Of the 217 subjects who underwent cervical spine computed tomography scans, 33 were identified with fractures of the cervical spine while 184 were not. The most common mechanisms of trauma, in order, for those with fractures were falls, followed by traffic accidents. We found that the injury severity score, multiple injuries, a high-energy injury mechanism, neurologic deficit, and pain and tenderness of the cervical spine showed statistically significant differences between the two groups. Conclusion: Fractures of the cervical spine that are not observed with simple radiography occur with a relatively high frequency in trauma patients. Consideration should be given to the risk factors for cervical spine fracture, and if pertinent, cervical spine computed tomography should be performed with speed for early diagnosis of cervical spine fractures.
Keywords
Cervical spine fracture; Computed tomography; Screening;
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1 Roberge RJ, Wears RC, Kelly M, et al. Selective application of cervical spine radiography in alert victims of blunt trauma: a prospective study. J Trauma 1988;28:784-8.   DOI   ScienceOn
2 Cadoux CG, White JD, Hedberg MC. High-yield roentgenographic criteria for cervical spine injuries. Ann Emerg Med 1987;16:738-42.   DOI   ScienceOn
3 Hoffmann JR, Mower WR, Wolfson AB, Todd KH, Zucker MI. Validity of a Set of Clinical Criteria to Rule Out Injury to the Cervical Spine in Patients with Blunt Trauma. N Engl J Med 2000;343:94-9.   DOI   ScienceOn
4 Stiell IG, Wells GA, Vandemheen K, Clement CM, Lesiuk H, De Maio VJ et al. Variation in emergency department use of cervical spine radiography for alert, stable trauma patients. CMAJ 1997;156:1537-44.
5 Daffner RH. Cervical radiography for trauma patients: a time-effective technique? AJR 2000;175:1309-11.   DOI   ScienceOn
6 Blahd WH, Iserson KV, Bjelland JC. Efficacy of the post-traumatic cross table lateral view of the cervical spine. J Emerg Med 1985;2:243-9.   DOI   ScienceOn
7 Holly LT, Kelly DF, Counelis GJ, Blinman T, McArthur DL, Cryer HG: Cervical spine trauma associated with moderate and severe head injury: Incidence, risk factors, and injury characteristics. J Neurosurg (Spine 3) 2002;96:285-91.
8 Williams J, Jehle D, Cottington E, Shufflebarger C. Head, facial, and clavicular trauma as a predictor of cervical-spine injury. Ann Emerg Med 1992;21:719-22.   DOI   ScienceOn
9 Sinclair D, Schwartz M, Gruss J, McLellan B. A retrospective review of the relationship between facial fractures, head injuries, and cervical spine injuries. J Emerg Med 1988;6:109-12.   DOI   ScienceOn
10 Jacobs LM, Schwartz R. Prospective analysis of acute cervical spine injury: a methodology to predict injury. Ann Emerg Med 1986;15:44-9.   DOI   ScienceOn
11 O'Malley KF, Ross SE. The incidence of injury to the cervical spine in patients with craniocervical injury. J Trauma 1988;28:1476-8.   DOI   ScienceOn
12 Fischer RP. Cervical radiographic evaluation of alert patients following blunt trauma. Ann Emerg Med 1984;13:905-7.   DOI   ScienceOn
13 Nunez DB Jr, Zuluaga A, Fuentes-Bernardo DA,Rivas LA, Becerra JL. Cervical spine trauma: how much more do we learn by routinely using helical CT? Radiographics 1996;16:1307-18.   DOI
14 Huang YH, Yang TM, LinWC, Ho JT, Lee TC, ChenWF, et al. The prognosis of acute blunt cervical spinal cord injury. J Trauma 2009;66:1441-5.   DOI
15 Davis JW, Phreaner DL, Hoyt DB, Mackersie RC. The etiology of missed cervical spine injuries. J Trauma 1993;34:342-6.   DOI   ScienceOn
16 Reid DC, Henderson R, Saboe L, Miller JD. Etiology and clinical course of missed spine fractures. J Trauma 1987;27:980-6.   DOI   ScienceOn
17 Rogers WA. Fractures and dislocations of the cervical spine: an end-result study. J Bone Joint Surg 1957;39:341-76.   DOI
18 Nunez DB Jr, Ahmad AA, Coin CG, et al. Clearing the cervical spine in multiple trauma victims: a time-effective protocol using helical CT. Emerg Radiol 1994;1:273-8.   DOI   ScienceOn
19 Davis JW, Phreaner DL, Hoyt DB,Mackersie RC. The etiology ofmissed cervical spine injuries. J Trauma. 1993;34:342-6.   DOI   ScienceOn
20 Daffner RH. Imaging of vertebral trauma, 2nd ed. Philadelphia: Lippincott-Raven, 1996:51-94
21 Shingu H, Ohama M, Ikata T, Katoh S, Akatsu T. A nationwide epidemiological survey of spinal cord injuries in Japan from January 1990 to December 1992. Paraplegia 1995;33:183-8.   DOI   ScienceOn
22 Lee KJ. The necessity for a trauma surgeon and the trauma surgeon's role in the trauma care system. J Korean Soc Traumatol 2008;21:1-7.
23 Berkowitz M. Assessing the socioeconomic impact of improved treatment of head and spinal cord injuries. J Emerg Med 1993;1:63-7.
24 Harris MB, Reichmann WM, Bono CM, Bouchard K, Corbett KL, Warholic N, et al. Mortality in elderly patients after cervical spine fractures. J Bone Joint Surg Am 2010;92:567-74.   DOI   ScienceOn
25 Death rates for the cause of death: Korea National Statistical Office. Available at:http://www.nso.go.kr. Accessed February 10 2011
26 Grossman MD, Reilly PM, Gillett T, Gillett D. National survey of the incidence of cervical spine injury and approach to cervical spine clearance in U.S. trauma centers. J Trauma. 1999;47:684-90.   DOI   ScienceOn
27 Bracken MB, Freeman DH, Hellenbrand K. Incidence of acute traumatic hospitalized spinal cord injury in the United States, 1970-1977. Am J Epidemiol 1981;113:615-22.   DOI
28 Fine PR, Kuhlemeier KV, DeVivo MJ, Stover SL. Spinal cord injury: an epidemiologic perspective. Paraplegia 1979;17:237-50.   DOI   ScienceOn