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Markowitz M, Woods B. On-Field Management of Suspected Spinal Cord Injury. Clin Sports Med 2021; 40:445-462. [PMID: 34051939 DOI: 10.1016/j.csm.2021.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Acute spinal cord injuries in athletes are rare. However, on-field management of such injuries requires a well-planned approach from a team of well-trained medical staff. Athletes wearing protective gear should be handled with care; a primary survey should be conducted to rule out life-threatening injury while concomitantly immobilizing the spine. Treatment with steroids or hypothermia have not been shown to be beneficial, ultimately time to surgery provides the athlete with the best chance of a good outcome.
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Affiliation(s)
- Michael Markowitz
- Rowan University School of Osteopathic Medicine Orthopedic Surgery, Stratford, NJ, USA
| | - Barrett Woods
- The Rothman Institute at Thomas Jefferson University Hospital, Philadelphia, PA, USA.
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Consensus Recommendations on the Prehospital Care of the Injured Athlete With a Suspected Catastrophic Cervical Spine Injury. Clin J Sport Med 2020; 30:296-304. [PMID: 32639439 DOI: 10.1097/jsm.0000000000000869] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Sports participation is among the leading causes of catastrophic cervical spine injury (CSI) in the United States. Appropriate prehospital care for athletes with suspected CSIs should be available at all levels of sport. The goal of this project was to develop a set of best-practice recommendations appropriate for athletic trainers, emergency responders, sports medicine and emergency physicians, and others engaged in caring for athletes with suspected CSIs. METHODS A consensus-driven approach (RAND/UCLA method) in combination with a systematic review of the available literature was used to identify key research questions and develop conclusions and recommendations on the prehospital care of the spine-injured athlete. A diverse panel of experts, including members of the National Athletic Trainers' Association, the National Collegiate Athletic Association, and the Sports Institute at UW Medicine participated in 4 Delphi rounds and a 2-day nominal group technique (NGT) meeting. The systematic review involved 2 independent reviewers and 4 rounds of blinded review. RESULTS The Delphi process identified 8 key questions to be answered by the systematic review. The systematic review comprised 1544 studies, 49 of which were included in the final full-text review. Using the results of the systematic review as a shared evidence base, the NGT meeting created and refined conclusions and recommendations until consensus was achieved. CONCLUSIONS These conclusions and recommendations represent a pragmatic approach, balancing expert experiences and the available scientific evidence.
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Courson R, Ellis J, Herring SA, Boden BP, Henry G, Conway D, McNamara L, Neal TL, Putukian M, Sills AK, Walpert KP. Best Practices and Current Care Concepts in Prehospital Care of the Spine-Injured Athlete in American Tackle Football March 2-3, 2019; Atlanta, GA. J Athl Train 2020; 55:545-562. [PMID: 32579669 PMCID: PMC7319739 DOI: 10.4085/1062-6050-430-19] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Sport-related spine injury can be devastating and have long-lasting effects on athletes and their families. Providing evidence-based care for patients with spine injury is essential for optimizing postinjury outcomes. When caring for an injured athlete in American tackle football, clinicians must make decisions that involve unique challenges related to protective equipment (eg, helmet and shoulder pads). The Spine Injury in Sport Group (SISG) met in Atlanta, Georgia, March 2-3, 2019, and involved 25 health care professionals with expertise in emergency medicine, sports medicine, neurologic surgery, orthopaedic surgery, neurology, physiatry, athletic training, and research to review the current literature and discuss evidence-based medicine, best practices, and care options available for the prehospital treatment of athletes with suspected cervical spine injuries.1,2 That meeting and the subsequent Mills et al publication delineate the quality and quantity of published evidence regarding many aspects of prehospital care for the athlete with a suspected cervical spine injury. This paper offers a practical treatment guide based on the experience of those who attended the Atlanta meeting as well as the evidence presented in the Mills et al article. Ongoing research will help to further advance clinical treatment recommendations.
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Affiliation(s)
| | - James Ellis
- University of South Carolina School of Medicine, Greenville
| | - Stanley A Herring
- Department of Rehabilitation Medicine and The Sports Institute, University of Washington, Seattle
| | - Barry P Boden
- The Orthopaedic Center, A Division of CAO, Rockville, MD
| | | | | | - Lance McNamara
- Barrow County Schools, Winder-Barrow High School, Winder, GA
| | | | - Margot Putukian
- University Health Services, Rugers Robert Wood Johnson Medical School, Princeton, NJ
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Mills BM, Conrick KM, Anderson S, Bailes J, Boden BP, Conway D, Ellis J, Feld F, Grant M, Hainline B, Henry G, Herring SA, Hsu WK, Isakov A, Lindley TR, McNamara L, Mihalik JP, Neal TL, Putukian M, Rivara FP, Sills AK, Swartz EE, Vavilala MS, Courson R. Consensus Recommendations on the Prehospital Care of the Injured Athlete With a Suspected Catastrophic Cervical Spine Injury. J Athl Train 2020; 55:563-572. [PMID: 32579668 DOI: 10.4085/1062-6050-0434.19] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
INTRODUCTION Sports participation is among the leading causes of catastrophic cervical spine injury (CSI) in the United States. Appropriate prehospital care for athletes with suspected CSIs should be available at all levels of sport. The goal of this project was to develop a set of best-practice recommendations appropriate for athletic trainers, emergency responders, sports medicine and emergency physicians, and others engaged in caring for athletes with suspected CSIs. METHODS A consensus-driven approach (RAND/UCLA method) in combination with a systematic review of the available literature was used to identify key research questions and develop conclusions and recommendations on the prehospital care of the spine-injured athlete. A diverse panel of experts, including members of the National Athletic Trainers' Association, the National Collegiate Athletic Association, and the Sports Institute at UW Medicine participated in 4 Delphi rounds and a 2-day nominal group technique meeting. The systematic review involved 2 independent reviewers and 4 rounds of blinded review. RESULTS The Delphi process identified 8 key questions to be answered by the systematic review. The systematic review comprised 1544 studies, 49 of which were included in the final full-text review. Using the results of the systematic review as a shared evidence base, the nominal group technique meeting created and refined conclusions and recommendations until consensus was achieved. CONCLUSIONS These conclusions and recommendations represent a pragmatic approach, balancing expert experiences and the available scientific evidence.
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Affiliation(s)
- Brianna M Mills
- Harborview Injury Prevention and Research Center, University of Washington, Seattle
| | - Kelsey M Conrick
- Harborview Injury Prevention and Research Center and School of Social Work, University of Washington, Seattle
| | | | | | - Barry P Boden
- The Orthopaedic Center, A Division of CAO, Rockville, MD
| | | | - James Ellis
- University of South Carolina School of Medicine, Greenville
| | | | | | - Brian Hainline
- Sports Science Institute, National Collegiate Athletic Association, Indianapolis, IN
| | | | - Stanley A Herring
- Department of Rehabilitation Medicine and The Sports Institute, University of Washington, Seattle
| | - Wellington K Hsu
- Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Alex Isakov
- Section of Prehospital and Disaster Medicine, Department of Emergency Medicine, Emory University School of Medicine, Atlanta, GA
| | | | - Lance McNamara
- Barrow County Schools, Winder-Barrow High School, Winder, GA
| | - Jason P Mihalik
- Matthew A. Gfeller Sport-Related Traumatic Brain Injury Research Center, Department of Exercise and Sport Science, University of North Carolina at Chapel Hill
| | | | - Margot Putukian
- University Health Services, Rutgers Robert Wood Johnson Medical School, Princeton, NJ
| | - Frederick P Rivara
- Harborview Injury Prevention and Research Center and Department of Pediatrics, University of Washington and Seattle Children's Hospital, WA
| | - Allen K Sills
- National Football League, New York, NY, Vanderbilt University Medical Center, Nashville, TN
| | | | - Monica S Vavilala
- Harborview Injury Prevention and Research Center, Department of Pediatrics, and Department of Anesthesiology, University of Washington, Seattle
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Jacobson B, Cendoma M, Gdovin J, Cooney K, Bruening D. Cervical spine motion during football equipment-removal protocols: a challenge to the all-or-nothing endeavor. J Athl Train 2013; 49:42-8. [PMID: 24377964 DOI: 10.4085/1062-6050-48.6.11] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
CONTEXT The National Athletic Trainers' Association position statement on acute management of the cervical spine-injured athlete recommended the all-or-nothing endeavor, which involves removing or not removing both helmet and shoulder pads, from equipment-laden American football and ice hockey athletes. However, in supporting research, investigators have not considered alternative protocols. OBJECTIVE To measure cervical spine movement (head relative to sternum) produced when certified athletic trainers (ATs) use the all-or-nothing endeavor and to compare these findings with the movement produced using an alternative pack-and-fill protocol, which involves packing the area under and around the cervical neck and head with rolled towels. DESIGN Crossover study. SETTING Movement analysis laboratory. PATIENTS OR OTHER PARTICIPANTS Eight male collegiate football players (age = 21.4 ± 1.4 years; height = 1.87 ± 0.02 m; mass = 103.6 ± 12.5 kg). INTERVENTION(S) Four ATs removed equipment under 4 conditions: removal of helmet only followed by placing the head on the ground (H), removal of the helmet only followed by pack-and-fill (HP), removal of the helmet and shoulder pads followed by placing the head on the ground (HS), and removal of the helmet and shoulder pads followed by pack-and-fill (HSP). Motion capture was used to track the movement of the head with respect to the sternum during equipment removal. MAIN OUTCOME MEASURE(S) We measured head movement relative to sternum movement (translations and rotations). We used 4 × 4 analyses of variance with repeated measures to compare discrete motion variables (changes in position and total excursions) among protocols and ATs. RESULTS Protocol HP resulted in a 0.1 ± 0.6 cm rise in head position compared with a 1.4 ± 0.3 cm drop with protocol HS (P < .001). Protocol HP produced 4.9° less total angular excursion (P < .001) and 2.1 cm less total vertical excursion (P < .001) than protocol HS. CONCLUSIONS The pack-and-fill protocol was more effective than shoulder pad removal in minimizing cervical spine movement throughout the equipment-removal process. This study provides evidence for including the pack-and-fill protocol in future treatment recommendations when helmet removal is necessary for on-field care.
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Scibek JS, Gatti JM, McKenzie JI. Successful removal of football helmet face-mask clips after 1 season of use. J Athl Train 2013; 47:428-34. [PMID: 22889659 DOI: 10.4085/1062-6050-47.4.10] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
CONTEXT Whereas many researchers have assessed the ability to remove loop straps in traditional face-mask attachment systems after at least 1 season of use, research in which the effectiveness of the Riddell Quick Release (QR) Face Guard Attachment System clip after 1 season has been assessed is limited. OBJECTIVE To examine the success rate of removing the QR clips after 1 season of use at the Football Championship Subdivision level. We hypothesized that 1 season of use would negatively affect the removal rate of the QR clip but repeated clip-removal trials would improve the removal rate. DESIGN Retrospective, quasi-experimental design. SETTING Controlled laboratory study. PATIENTS OR OTHER PARTICIPANTS Sixty-three football helmets from a National Collegiate Athletic Association Division I university located in western Pennsylvania used during the 2008 season were tested. INTERVENTION(S) Three certified athletic trainers (2 men, 1 woman; age = 31.3 ± 3.06 years, time certified = 9.42 ± 2.65 years) attempted to remove the QR clips from each helmet with the tool provided by the manufacturer. Helmets then were reassembled to allow each athletic trainer to attempt clip removal. MAIN OUTCOME MEASURE(S) The dependent variables were total left clips removed (TCR-L), total right clips removed (TCR-R), and total clips removed (TCR). Success rate of clip removal (SRCR) also was assessed. RESULTS Percentages for TCR-L, TCR-R, and TCR were 100% (189 of 189), 96.30% (182 of 189), and 98.15% (371 of 378), respectively. A paired-samples t test revealed a difference between TCR-R and TCR-L (t(188) = 2.689, P = .008, μ(d) = 0.037, 95% confidence interval [CI] = 0.064, 0.010). The percentage for SRCR was 96.30% (n = 182), whereas SRCR percentages for trials 1, 2, and 3 were 95.24% (n = 60), 98.41% (n = 62), and 95.24% (n = 60), respectively, and did not represent a difference (F(2,186) = 0.588, P = .56, 95% (CI) = 0.94, 0.99). CONCLUSIONS Our results indicated favorable and consistent success rates for QR clip removal after 1 season of use. Whereas the QR clip is an advancement in face-mask technology, continued examination of this system is required to ensure the highest level of function, allowing for effective management of the helmeted athlete.
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Affiliation(s)
- Jason S Scibek
- Department of Athletic Training, Duquesne University, 600 Forbes Avenue, 118 Health Sciences, Pittsburgh, PA 15282, USA.
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Petschauer MA, Schmitz R, Gill DL. Helmet fit and cervical spine motion in collegiate men's lacrosse athletes secured to a spine board. J Athl Train 2011; 45:215-21. [PMID: 20446833 DOI: 10.4085/1062-6050-45.3.215] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
CONTEXT Proper management of cervical spine injuries in men's lacrosse players depends in part upon the ability of the helmet to immobilize the head. OBJECTIVE To determine if properly and improperly fitted lacrosse helmets provide adequate stabilization of the head in the spine-boarded athlete. DESIGN Crossover study. SETTING Sports medicine research laboratory. PATIENTS OR OTHER PARTICIPANTS Eighteen healthy collegiate men's lacrosse players. INTERVENTION(S) Participants were asked to move their heads through 3 planes of motion after being secured to a spine board under 3 helmet conditions. MAIN OUTCOME MEASURE(S) Change in range of motion in the cervical spine was calculated for the sagittal, frontal, and transverse planes for both head-to-thorax and helmet-to-thorax range of motion in all 3 helmet conditions (properly fitted, improperly fitted, and no helmet). RESULTS Head-to-thorax range of motion with the properly fitted and improperly fitted helmets was greater than in the no-helmet condition (P < .0001). In the sagittal plane, range of motion was greater with the improperly fitted helmet than with the properly fitted helmet. No difference was observed in helmet-to-thorax range of motion between properly and improperly fitted helmet conditions. Head-to-thorax range of motion was greater than helmet-to-thorax range of motion in all 3 planes (P < .0001). CONCLUSIONS Cervical spine motion was minimized the most in the no-helmet condition, indicating that in lacrosse players, unlike football players, the helmet may need to be removed before stabilization.
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Higgins M, Tierney RT, Driban JB, Edell S, Watkins R. Lacrosse equipment and cervical spinal cord space during immobilization: preliminary analysis. J Athl Train 2011; 45:39-43. [PMID: 20064046 DOI: 10.4085/1062-6050-45.1.39] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
CONTEXT Removal of the lacrosse helmet to achieve airway access has been discouraged based only on research in which cervical alignment was examined. No researchers have examined the effect of lacrosse equipment on the cervical space available for the spinal cord (SAC). OBJECTIVE To determine the effect of lacrosse equipment on the cervical SAC and cervical-thoracic angle (CTA) in the immobilized athlete. DESIGN Observational study. SETTING Outpatient imaging center. PATIENTS OR OTHER PARTICIPANTS Ten volunteer lacrosse athletes (age = 20.7 +/- 1.87 years, height = 180.3 +/- 8.3 cm, mass = 91 +/- 12.8 kg) with no history of cervical spine injury or disease and no contraindications to magnetic resonance imaging (MRI). INTERVENTION(S) The lacrosse players were positioned supine on a spine board for all test conditions. An MRI scan was completed for each condition. MAIN OUTCOME MEASURE(S) The independent variables were condition (no equipment, shoulder pads only [SP], and full gear that included helmet and shoulder pads [FG]), and cervical spine level (C3-C7). The dependent variables were the SAC and CTA. The MRI scans were evaluated midsagittally. The average of 3 measures was used as the criterion variable. The SAC data were analyzed using a 3 x 5 analysis of variance (ANOVA) with repeated measures. The CTA data were analyzed with a 1-way repeated-measures ANOVA. RESULTS We found no equipment x level interaction effect (F(3.7,72) = 1.34, P = .279) or equipment main effect (F(2,18) = 1.20, P = .325) for the SAC (no equipment = 5.04 +/- 1.44 mm, SP = 4.69 +/- 1.36 mm, FG = 4.62 +/- 1.38 mm). The CTA was greater (ie, more extension; critical P = .0167) during the SP (32.64 degrees +/- 3.9 degrees) condition than during the no-equipment (25.34 degrees +/- 2.3 degrees ; t(9) = 7.67, P = .001) or FG (26.81 degrees +/- 5.1 degrees; t(9) = 4.80, P = .001) condition. CONCLUSIONS Immobilizing healthy lacrosse athletes with shoulder pads and no helmets affected cervical spine alignment but did not affect SAC. Further research is needed to determine and identify appropriate care of the lacrosse athlete with a spine injury.
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Affiliation(s)
- Michael Higgins
- Department of Kinesiology, Towson University, Towson, MD 21252, USA.
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Swartz EE, Boden BP, Courson RW, Decoster LC, Horodyski M, Norkus SA, Rehberg RS, Waninger KN. National athletic trainers' association position statement: acute management of the cervical spine-injured athlete. J Athl Train 2010; 44:306-31. [PMID: 19478836 DOI: 10.4085/1062-6050-44.3.306] [Citation(s) in RCA: 86] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To provide certified athletic trainers, team physicians, emergency responders, and other health care professionals with recommendations on how to best manage a catastrophic cervical spine injury in the athlete. BACKGROUND The relative incidence of catastrophic cervical spine injury in sports is low compared with other injuries. However, cervical spine injuries necessitate delicate and precise management, often involving the combined efforts of a variety of health care providers. The outcome of a catastrophic cervical spine injury depends on the efficiency of this management process and the timeliness of transfer to a controlled environment for diagnosis and treatment. RECOMMENDATIONS Recommendations are based on current evidence pertaining to prevention strategies to reduce the incidence of cervical spine injuries in sport; emergency planning and preparation to increase management efficiency; maintaining or creating neutral alignment in the cervical spine; accessing and maintaining the airway; stabilizing and transferring the athlete with a suspected cervical spine injury; managing the athlete participating in an equipment-laden sport, such as football, hockey, or lacrosse; and considerations in the emergency department.
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Swartz EE, Decoster LC, Norkus SA, Boden BP, Waninger KN, Courson RW, Horodyski M, Rehberg RS. Summary of the National Athletic Trainers' Association position statement on the acute management of the cervical spine-injured athlete. PHYSICIAN SPORTSMED 2009; 37:20-30. [PMID: 20048537 DOI: 10.3810/psm.2009.12.1738] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The incidence of catastrophic cervical spine injury in sports is low compared with other injuries. However, cervical spine injuries necessitate delicate and precise management, often involving the combined efforts of a variety of health care providers. The outcome of a catastrophic cervical spine injury depends on the efficiency of this management process and timeliness of transfer to a controlled environment for diagnosis and treatment. The objective of the National Athletic Trainers' Association (NATA) position statement on the acute care of the cervical spine-injured athlete is to provide the certified athletic trainer, team physician, emergency responder, and other health care professionals with recommendations on how to best manage a catastrophic cervical spine injury in an athlete. Recommendations are based on current evidence pertaining to prevention strategies to reduce the incidence of cervical spine injuries in sport; emergency planning and preparation to increase management efficiency; maintaining or creating neutral alignment in the cervical spine; accessing and maintaining the airway; stabilizing and transferring the athlete with a suspected cervical spine injury; managing the athlete participating in an equipment-laden sport such as football, hockey, or lacrosse; and imaging considerations in the emergency department.
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Mihalik JP, Beard JR, Petschauer MA, Prentice WE, Guskiewicz KM. Effect of ice hockey helmet fit on cervical spine motion during an emergency log roll procedure. Clin J Sport Med 2008; 18:394-8. [PMID: 18806545 DOI: 10.1097/jsm.0b013e31818115e3] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To investigate cervical spine motion during a log roll technique in ice hockey players under different helmet fit conditions. DESIGN Prospective counterbalanced design. SETTING University research laboratory. PARTICIPANTS Eighteen club ice hockey players were recruited to participate in this study. ASSESSMENT OF RISK FACTORS A standard emergency log roll was performed 3 times under each of 3 different helmet fit conditions: properly fit, improperly (competition) fit, and helmet-removed. MAIN OUTCOME MEASUREMENTS Frontal, sagittal, and transverse plane cervical spine motion were used as outcome measures. RESULTS Significantly less sagittal and transverse plane motion occurred during the helmet-removed condition. No differences in frontal plane motion among the 3 conditions were observed. CONCLUSIONS Presence of helmet (whether properly fit or not) resulted in increased of sagittal and transverse plane movement. This suggests that when an ice hockey helmet is stabilized, the head within it is not. We recommend the helmet and face shield be removed before performing an emergency prone log roll.
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Affiliation(s)
- Jason P Mihalik
- Department of Exercise and Sport Science, Sports Medicine Research Laboratory, The University of North Carolina, Chapel Hill, North Carolina 27599, USA.
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Treme G, Diduch DR, Hart J, Romness MJ, Kwon MS, Hart JM. Cervical spine alignment in the youth football athlete: recommendations for emergency transportation. Am J Sports Med 2008; 36:1582-6. [PMID: 18354145 DOI: 10.1177/0363546508315040] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Substantial literature exists regarding recommendations for the on-field treatment and subsequent transportation of adult collision-sport athletes with a suspected injury to the cervical spine. PURPOSE To develop an evidence-based recommendation for transportation of suspected spine-injured youth football players. STUDY DESIGN Descriptive laboratory study. METHODS Three lateral radiographs were obtained in supine to include the occiput to the cervical thoracic junction from 31 youth football players (8-14 years). Each child was imaged while wearing helmet and shoulder pads, without equipment, and with shoulder pads only. Two independent observers measured cervical spine angulation as Cobb angle from C1 to C7 and subaxial angulation from C2 to C7. We calculated intraclass correlation coefficients for intraobserver reliability analysis and compared Cobb and C2 to C7 angles between equipment conditions with t tests. RESULTS Interobserver analysis showed excellent reliability among measurements. Cobb and subaxial angle measurements indicated significantly greater cervical lordosis while children wore shoulder pads only, compared with the other 2 conditions (no equipment and helmet and shoulder pads) (P <or= .001). There was no statistically significant difference in either Cobb or C2-C7 angles between fully equipped (helmet + shoulder pads) and no-equipment conditions (P >.05). CONCLUSIONS Equipment removal for the youth football athlete with suspected cervical spine injury should abide by the "all or none" policy that has been widely accepted for adult athletes. Helmet and shoulder pads should be left in place during emergency transport of the suspected spine-injured youth athlete. CLINICAL RELEVANCE Despite differences in head to torso size ratios between youth and adult players, helmet removal alone is not recommended for either during emergency transportation.
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Affiliation(s)
- Gehron Treme
- University of Virginia, Department of Orthopaedic Surgery, Charlottesville, Virginia, USA
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Bell K. On-field issues of the C-spine-injured helmeted athlete. Curr Sports Med Rep 2007; 6:32-5. [PMID: 17212910 DOI: 10.1007/s11932-007-0009-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Football is a violent collision sport and can lead to various serious injuries. Cervical spine injuries are numerous, ranging from bony fractures and dislocations to spinal cord disruption. These injuries can be a devastating and debilitating. Although most injuries that occur are self-limiting there is a significant proportion that can cause permanent disability. Due to the equipment used in football, unique on-field care is implemented in evaluating athletes with possible cervical spine injury. Early preseason preparation and proper on-field intervention can help improve outcomes for these athletes.
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Affiliation(s)
- Kameno Bell
- Department of Family Medicine, Indiana University School of Medicine, 4752 Kimbark, Chicago, IL 60615, USA.
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Banerjee R, Palumbo MA, Fadale PD. Catastrophic cervical spine injuries in the collision sport athlete, part 2: principles of emergency care. Am J Sports Med 2004; 32:1760-4. [PMID: 15494346 DOI: 10.1177/0363546504268931] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Catastrophic cervical spine injuries can lead to devastating consequences for the collision athlete. Improved understanding of these injuries can lead to identification of risk factors, early diagnosis, and effective on-field management. This article is the second in a 2-part series. The first part, published in the June 2004 issue, reviewed the current concepts regarding the epidemiology, functional anatomy, and diagnostic considerations relevant to cervical spine trauma in collision sports. In this article, the principles of on-field emergency care of the spine-injured athlete are reviewed. The authors discuss the need for effective pre-event planning, on-field evaluation and management of cervical spine injuries, and the transition of care from the playing field to the emergency room. The protocol for equipment removal, when necessary, is also reviewed. An organized, rapid approach to the management of cervical spine-injured collision athletes can help to optimize the outcomes of these catastrophic injuries.
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Affiliation(s)
- Rahul Banerjee
- Department of Orthopaedic Surgery, Brown Medical School, Providence, Rhode Island, USA
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Abstract
Improper handling of an unstable neck injury may result in iatrogenic neurologic injury. A review of published evidence on cervical management in the helmeted athlete with a suspected spinal injury is discussed. The approach to the neck-injured helmeted athlete and the algorithms for on-field and emergency department evaluations are reviewed. The characteristics of the fitted football helmet allow safe access for airway management, and helmets and shoulder pads should not be initially removed unless absolutely necessary. Prehospital and emergency personnel should be trained in the indications for removal and in proper helmet, shoulder pad, and facemask removal techniques. If required, both helmet and shoulder pads should be removed simultaneously. Radiographs with equipment in place may be inadequate, and the value of computed tomography and magnetic resonance imaging in these helmeted patients has been studied. If adequate films cannot be obtained with equipment in place, helmet and shoulder pads may need to be removed before radiographic clearance. A plan should be formulated to prepare for such unexpected clinical scenarios as cervical spine injuries, and skills should be practiced. Airway and cervical spine management in these helmeted athletes is an area of ongoing research.
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Affiliation(s)
- Kevin N Waninger
- Department of Emergency Medicine, Saint Luke's Hospital, Bethlehem, PA, USA.
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