AbstractBackgroundCervical spine injury (CSI) can be ruled out based on clinical examination and no X-ray is required if patient is awake, alert, and examinable. This is known as a clinical clearance (CC). Clinicians have decreased the use and reliance of CC and relied more upon X-ray, especially now that computerized tomography (CT) is fast and readily available. The objective of this study was to identify clinical factors, in particular, the injury mechanism and the distracting injuries, which may be associated with CSI. The knowledge may help to improve the use of CC.MethodsWe retrospectively reviewed the records of all blunt trauma patients who were awake, alert, and examinable, with a Glasgow Coma Scale of 14–15, and who were admitted to our Level 1 Trauma Center during January 1 to December 31, 2005. We excluded patients who presented with gross neurological deficit or who died within 72h. From the chart review, we collected the demographics; the injury severity score (ISS); the injury mechanism; the presence of distracting injuries (DI) which were defined as bony fractures (divided into upper body, lower body, or both); and the radiographs obtained. Patients who did not receive CC underwent a 3-view plain film X-ray, with or without CT scan. We then divided the group into those with CSI (Case) and those without (Control). We compared the two group variables and performed a multiple logistic regression analysis to identify clinical factors associated with CSI. Statistical significance was accepted with p-value <0.05.ResultsOf the 985 patients evaluated, only 179 (18%) received CC. The remaining did not receive CC and went on to have radiographs. Of these, 76 were diagnosed CSI (Case). On a univariate analysis, the ISS, a motor vehicle collision (MVC) with rollover; MVC with rollover and ejection, the absence of DI, and a lower-body DI were significantly associated with CSI. However, on a multivariate analysis, only an MVC with rollover (odds ratio [OR], 2.326; 95% confidence interval [CI], 1.36–3.97) and a lower-body distracting injury (OR, 0.20; 95% CI, 0.07–0.55) were significantly associated with CSI.ConclusionThe injury mechanism of MVC with rollover may prevent clinicians from utilizing CC, while the presence of a lower-body DI should not. A future and prospective study is needed to better understand the role of the injury mechanism and the distracting injury in relation to CSI.


    Access

    Check access

    Check availability in my library

    Order at Subito €


    Export, share and cite



    Title :

    Decreased use of cervical spine clearance in blunt trauma: The implication of the injury mechanism and distracting injury


    Contributors:
    Kulvatunyou, N. (author) / Lees, J.S. (author) / Bender, J.B. (author) / Bright, B. (author) / Albrecht, R. (author)

    Published in:

    Publication date :

    2009-12-31


    Size :

    5 pages




    Type of media :

    Article (Journal)


    Type of material :

    Electronic Resource


    Language :

    English





    Cervical spine injury mechanisms

    Myers,B.S. / McElhaney,J.H. / Nightingale,R. et al. | Automotive engineering | 1994


    Cervical Spine Injury Mechanisms

    Huelke, D. E. / Montalvo, F. / Nusholtz, G. S. et al. | SAE Technical Papers | 1983


    Cervical Spine Injury Mechanisms

    Nusholtz, G. S. / Huelke, D. E. / Lux, P. et al. | British Library Conference Proceedings | 1983


    Injury mechanism hyphotheses for cervical spine distorsion injury at rear-end car collisions

    Hell, W. / Langwieder, K. / Schick, S. et al. | British Library Conference Proceedings | 2000