BackgroundEpidemiology of cervical spine fractures (CSfx) in trauma patients of general population is not yet exclusively known.ObjectivesThe purpose of this study was to evaluate the epidemiology of CSfx in trauma patients.Patients and MethodsData from trauma patients admitted in the emergency room (ER) of Shiraz Shahid Rajaei hospital during the 3.5 years period from September 22, 2009 to March 21, 2013, were gathered. All trauma patients with CSfx and/or spinal cord injuries were included in the study. The time of the trauma, mechanism of trauma, injury position, and incidence of cervical spine fractures in the patients were recorded.ResultsA total of 469 patients met the inclusion criteria. The mean age of the patients was 34.7 years old, with a minimum age of 16 years old and a maximum age of 89 years old. Young adults were most frequently affected. Out of 469 cases, 368 patients (78.47%) were male and 101 (21.53%) were female. We had a total of 17 SCI cases among our patients (3.62%), out of which 5 (29.41%) were deceased. The total number of deaths in our study was 29 (6.18%); 5 (17.24%) with SCI and 24 (82.76%) without SCI.ConclusionsThis study demonstrated that most victims of CSfx in our region are 16 to 40 years of age. A male predominance was observed, and motor vehicle collisions were the most frequent trauma mechanism leading to cervical spine injury (mostly due to car rollover accidents), with falls as the second most frequent. The rate of SCI in our study was 3.62% of all cases and the mortality rate was 6.18%.

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ObjectivesThe triage of trauma patients with potential COVID-19 remains a major challenge given that a significant number of patients may be asymptomatic or pre-symptomatic. This study aimed to compare the specificity and sensitivity of available triage systems for COVID-19 among trauma patients. Furthermore, it aimed to develop a novel triage system for SARS-CoV-2 detection among trauma patients in centers with limited resources.MethodsAll patients referred to our center from February to May 2020 were enrolled in this prospective study. We evaluated the SARS-CoV-2 triage protocols from the WHO, the Iranian Ministry of Health and Medical Education (MOHME), and the European Centre for Disease Control and Prevention (ECDC) for their effectiveness in finding COVID-19 infected individuals among trauma patients. We then used these data to design a stepwise triage protocol to detect COVID-19 positive patients among trauma patients.ResultsAccording to our findings, the WHO protocol showed 100% specificity and 13.3% sensitivity. The MOHME protocol had 99% specificity and 23.3% sensitivity. While the ECDC protocol showed 93.3% sensitivity and 89.5% specificity, it did not prioritize patients based on traumatic injuries and unstable conditions. Our stepwise triage protocol, which prioritizes traumatic injuries, had 93.3% sensitivity and 90.3% specificity.ConclusionOur study shows that the triage protocols from the WHO, MOHME and ECDC are not best equipped to diagnose SARS-CoV-2 infected individuals among trauma patients. In our proposed stepwise triage system, patients are triaged according to their hemodynamic conditions, COVID-19 related clinical states, and COVID-19 related laboratory findings. Our triage model can lead to more accurate and resource-effective management of trauma patients with potential COVID-19 infection.Level of evidenceLevel Ⅲ.

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Propose In this study, we re-assessed the criteria defined by the radiological society of north America (RSNA) to determine novel radiological findings helping the physicians differentiating COVID-19 and pulmonary contusion. Methods All trauma patients with blunt chest wall trauma and subsequent pulmonary contusion, COVID-19-related signs and symptoms before the trauma were enrolled in this retrospective study from February to May 2020. Included patients (Group P) were then classified into two groups based on polymerase chain reaction tests (Group Pa for positive patients and Pb for negative ones). Moreover, 44 patients from the pre-pandemic period (Group PP) were enrolled. They were matched to group P regarding age, sex, and trauma-related scores. Two radiologists blindly reviewed the CT images of all enrolled patients according to criteria defined by the RSNA criteria. The radiological findings were compared between group P and PP; statistically significant ones were re-evaluated between Pa and Pb thereafter. Finally, the sensitivity and specificity of each significant findings were calculated. The Chi-square test was used to compare the radiological findings between two groups. Results In the group PP, 73.7% of all ground-glass opacities (GGOs) and 80% of all multiple bilateral GGOs were detected ( p < 0.001 and p = 0.25, respectively). Single bilateral GGOs were only seen among the group PP. The Chi-square tests showed that the prevalence of diffused GGOs, multiple unilateral GGOs, multiple consolidations, and multiple bilateral consolidations were significantly higher in the group P ( p = 0.001, 0.01, 0.003, and 0.003, respectively). However, GGOs with irregular borders and single consolidations were more significant among the group PP ( p = 0.01 and 0.003, respectively). Of note, reticular distortions and subpleural spares were exclusively detected in the group PP. Conclusion We concluded that the criteria set by RSNA for the diagnosis of COVID-19 are not appropriate in trauma patients. The clinical signs and symptoms are not always useful either. The presence of multiple unilateral GGOs, diffused GGOs, and multiple bilateral consolidations favor COVID-19 with 88%, 97.62%, and 77.7% diagnostic accuracy.