Zuverlässigkeit notärztlicher Verdachtsdiagnosen

Helm, Matthias; Faul, Margaret M.; Unger, Thomas; Lampl, L.

doi:10.1007/s00101-013-2255-x

Cited by 16 publications

(2 citation statements)

References 23 publications

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“…Therefore, hemodynamic instability should be interpreted as a sign of high overall injury severity, which affects the spine in general and the cervical spine in particular. The fact that nearly 50% of the diagnostic certainty is faulty is regularly described in the literature and underlines the need for a simple but easy-to-use decision aid for (prehospital) immobilization [29,34].…”

Section: Discussionmentioning

confidence: 99%

Epidemiology and predictors of traumatic spine injury in severely injured patients: implications for emergency procedures

Häske

Lefering

Stock

et al. 2020

Eur J Trauma Emerg Surg

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Purpose This study aimed to identify the prevalence and predictors of spinal injuries that are suitable for immobilization. Methods Retrospective cohort study drawing from the multi-center database of the TraumaRegister DGU®, spinal injury patients ≥ 16 years of age who scored ≥ 3 on the Abbreviated Injury Scale (AIS) between 2009 and 2016 were enrolled. Results The mean age of the 145,833 patients enrolled was 52.7 ± 21.1 years. The hospital mortality rate was 13.9%, and the mean injury severity score (ISS) was 21.8 ± 11.8. Seventy percent of patients had no spine injury, 25.9% scored 2–3 on the AIS, and 4.1% scored 4–6 on the AIS. Among patients with isolated traumatic brain injury (TBI), 26.8% had spinal injuries with an AIS score of 4–6. Among patients with multi-system trauma and TBI, 44.7% had spinal injuries that scored 4–6 on the AIS. Regression analysis predicted a serious spine injury (SI; AIS 3–6) with a prevalence of 10.6% and cervical spine injury (CSI; AIS 3–6) with a prevalence of 5.1%. Blunt trauma was a predictor for SI and CSI (OR 4.066 and OR 3.640, respectively; both p < 0.001) and fall > 3 m for SI (OR 2.243; p < 0.001) but not CSI (OR 0.636; p < 0.001). Pre-hospital shock was predictive for SI and CSI (OR 1.87 and OR 2.342, respectively; both p < 0.001), and diminished or absent motor response was also predictive for SI (OR 3.171) and CSI (OR 7.462; both p < 0.001). Patients over 65 years of age were more frequently affected by CSI. Conclusions In addition to the clinical symptoms of pain, we identify ‘4S’ [spill (fall) > 3 m, seniority (age > 65 years), seriously injured, skull/traumatic brain injury] as an indication for increased attention for CSIs or indication for spinal motion restriction.

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Section: Discussionmentioning

confidence: 99%

Epidemiology and predictors of traumatic spine injury in severely injured patients: implications for emergency procedures

Häske

Lefering

Stock

et al. 2020

Eur J Trauma Emerg Surg

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“…Usually, in the prehospital setting the existence of a cervical spine injury reveals unclear. Studies suggest that spinal injuries are the most underestimated injuries in trauma patients [ 60 , 61 ]. Thus, application of a cervical collar remains nowadays a standard procedure in prehospital trauma care, recommended by recent protocols [ 20 ] and guidelines [ 21 ].…”

Section: Discussionmentioning

confidence: 99%

Motion and dural sac compression in the upper cervical spine during the application of a cervical collar in case of unstable craniocervical junction—A study in two new cadaveric trauma models

et al. 2018

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BackgroundUnstable conditions of the craniocervical junction such as atlanto-occipital dislocation (AOD) or atlanto-axial instability (AAI) are severe injuries with a high risk of tetraplegia or death. Immobilization by a cervical collar to protect the patient from secondary damage is a standard procedure in trauma patients. If the application of a cervical collar to a patient with an unstable craniocervical condition may cause segmental motion and secondary injury to the spinal cord is unknown.The aim of the current study is (i) to analyze compression on the dural sac and (ii) to determine relative motion of the cervical spine during the procedure of applying a cervical collar in case of ligamentous unstable craniocervical junction.Methods and findingsLigamentous AOD as well as AOD combined with ligamentous AAI was simulated in two newly developed cadaveric trauma models. Compression of the dural sac and segmental angulation in the upper cervical spine were measured on video fluoroscopy after myelography during the application of a cervical collar. Furthermore, overall three-dimensional motion of the cervical spine was measured by a motion tracking system.In six cadavers each, the two new trauma models on AOD and AOD combined with AAI could be implemented. Mean dural sac compression was significantly increased to -1.1 mm (-1.3 to -0.7 mm) in case of AOD and -1.2 mm (-1.6 to -0.6 mm) in the combined model of AOD and AAI. Furthermore, there is a significant increased angulation at the C0/C1 level in the AOD model. Immense three-dimensional movement up to 22.9° of cervical spine flexion was documented during the procedure.ConclusionThe current study pointed out that applying a cervical collar in general will cause immense three-dimensional movement. In case of unstable craniocervical junction, this leads to a dural sac compression and thus to possible damage to the spinal cord.

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