Head, facial, and clavicular trauma as a predictor of cervical-spine injury

Williams, J M; Jehle, Dietrich; Cottington, Eric; Shufflebarger, Charles M.

doi:10.1016/s0196-0644(05)82786-6

Cited by 78 publications

(44 citation statements)

References 14 publications

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“…'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].…”

Section: Discussionmentioning

confidence: 99%

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%

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

Morris¹,

McCoy²

2004

Anaesthesia

106

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“…Scattered studies of CSI in clinical series composed of all trauma patients report CSI prevalences ranging from 1 to 14%. 59,87 However, unevaluable patients require a higher index of suspicion than the general trauma population, 5,46,51,64,80,96 with one patient series estimating that a GCS score ≤ 8 incurs an almost 6-fold increase in the risk of CSI.…”

mentioning

confidence: 99%

Prevalence of cervical spinal injury in trauma

Milby

Halpern

Guo

et al. 2008

FOC

121

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Object Diagnosis of cervical spinal injury (CSI) is an essential aspect of the trauma evaluation. This task is especially difficult in patients who are not clinically able to be evaluated (unevaluable) because of distracting painful injuries, intoxication, or concomitant head injury. For this population, the appropriate use of advanced imaging techniques for cervical spinal clearance remains undetermined. This study was undertaken to estimate the prevalence of unstable CSI, particularly among patients in whom clinical evaluation is impossible or unreliable. Methods Estimates of the prevalence of CSI in populations consisting of all trauma patients, alert patients only, and clinically unevaluable patients only were determined by variance-weighted pooling of data from 65 publications (281,864 patients) that met criteria for review. Results The overall prevalence of CSI among all trauma patients was 3.7%. The prevalence of CSI in alert patients was 2.8%, whereas unevaluable patients were at increased risk of CSI with a prevalence of 7.7% (p = 0.007). Overall, 41.9% of all CSI cases were considered to exhibit instability. Conclusions Trauma patients who are clinically unevaluable have a higher prevalence of CSI than alert patients. Knowledge of the prevalence and risk of such injuries may help establish an evidence-based approach to the detection and management of clinically occult CSI.

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“…However, even in the absence of above mentioned factors, spine immobilization should be applied until lateral cervical spine X-ray is negative [4]. The American College of Surgeons suggests high risk of CSI with injuries above the clavicle level [5]; others do not agree with this correlation [6]. We reviewed the medical literature using cervical spine injury, face trauma and related terminologies for such correlation studies and found ten relevant studies ( Table 1).…”

Section: Discussionmentioning

confidence: 99%

Pentaplegia and Facial Bone Fracture: A Survivable Injury

K¹

2015

J Spine

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Pentaplegia is a spinal cord injury at or above C4 level, resulting in complete loss of motor functions below the injury level and paralysis of respiratory muscles. Facial injuries might be a factor for early identification of these patients and in implying prompt management. Here, we report a patient who was injured in a motor vehicle accident and sustained facial injury and cardiopulmonary symptoms. His imaging studies showed atlanto-axial dissociation and maxillary fracture. He survived the accident but continued to have pentaplegia. Presence of facial fractures might help in suspicion and early identification of such injuries, where prompt management remains essential for survival in complete pentaplegia and for avoiding deterioration in incomplete injuries.

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Head, facial, and clavicular trauma as a predictor of cervical-spine injury

Cited by 78 publications

References 14 publications

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

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

Prevalence of cervical spinal injury in trauma

Pentaplegia and Facial Bone Fracture: A Survivable Injury

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