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Dion PM, Lapierre M, Said H, Tremblay S, Tariq K, Lamb T, English SW, Kingstone M, Stratton A, Boet S, Shorr R, Lampron J. Rethinking cervical spine clearance in obtunded trauma patients: An updated systematic review and meta-analysis. Injury 2024; 55:111308. [PMID: 38266326 DOI: 10.1016/j.injury.2023.111308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Revised: 12/23/2023] [Accepted: 12/29/2023] [Indexed: 01/26/2024]
Abstract
BACKGROUND Cervical spine injuries (CSI) are often challenging to diagnose in obtunded adult patients with blunt trauma and the optimal imaging modality remains uncertain. This study systematically synthesized the last decade of evidence to determine the type of imaging required to clear the c-spine in obtunded patients with blunt trauma. METHODS A systematic review with meta-analysis was conducted and reported using PRISMA 2020 guidelines. The protocol was registered on June 22, 2022 (PROSPERO CRD42022341386). MEDLINE (Ovid), EMBASE, and Cochrane Library were searched for studies published between January 1, 2012, and October 17, 2023. Studies comparing CT alone to CT combined with MRI for c-spine clearance were included. Two independent reviewers screened articles for eligibility in duplicate. Meta-analysis was conducted using a random-effect model. Risk of bias and quality assessment were performed using the ROBINS-I and QUADAS-2. The certainty of evidence was assessed using the GRADE methodology. RESULTS 744 obtunded trauma patients from six included studies were included. Among the 584 that had a negative CT scan, the pooled missed rate of clinically significant CSI using CT scans alone was 6 % (95 % CI: 0.02 to 0.17), and the pooled missed rate of CSI requiring treatment was 7 % (95 % CI: 0.02 to 0.18). High heterogeneity was observed among included studies (I² > 84 %). The overall risk of bias was moderate, and the quality of evidence was low due to the retrospective nature of the included studies and high heterogeneity. CONCLUSIONS Limited evidence published in the last decade found that CT scans alone may not be sufficient for detecting clinically significant CSI and injuries requiring treatment in obtunded adult patients with blunt trauma. IMPLICATIONS OF KEY FINDINGS Clinicians should be aware of the limitations of CT scans and consider using MRI when appropriate. Future research should focus on prospective studies with standardized outcome measures and uniform reporting.
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Affiliation(s)
- Pierre-Marc Dion
- Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada; Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | | | - Hussein Said
- Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Sophie Tremblay
- Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Khadeeja Tariq
- Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Tyler Lamb
- Division of General Surgery, Department of Surgery, The Ottawa Hospital, University of Ottawa, Ottawa, ON, Canada
| | - Shane W English
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada; Department of Medicine (Critical Care), The Ottawa Hospital, University of Ottawa, Ottawa, ON, Canada
| | - Michael Kingstone
- Department of Medical Imaging, The Ottawa Hospital, Ottawa, ON, Canada
| | - Alexandra Stratton
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada; Division of Orthopedic Surgery, Department of Surgery, The Ottawa Hospital, University of Ottawa, Ottawa, ON, Canada
| | - Sylvain Boet
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada; Department of Anesthesiology and Pain Medicine, The Ottawa Hospital, University of Ottawa, Ottawa, ON, Canada; Department of Innovation in Medical Education, University of Ottawa, Ottawa, ON, Canada; Institut du Savoir Montfort, Ottawa, ON, Canada
| | - Risa Shorr
- Library Services, The Ottawa Hospital, Ottawa, ON, Canada
| | - Jacinthe Lampron
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada; Division of General Surgery, Department of Surgery, The Ottawa Hospital, University of Ottawa, Ottawa, ON, Canada.
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Marchesini N, Demetriades AK, Peul WC, Tommasi N, Zanatta P, Pinna G, Sala F. Concomitant trauma of brain and upper cervical spine: lessons in injury patterns and outcomes. Eur J Trauma Emerg Surg 2023:10.1007/s00068-023-02278-w. [PMID: 37184568 DOI: 10.1007/s00068-023-02278-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2023] [Accepted: 05/02/2023] [Indexed: 05/16/2023]
Abstract
PURPOSE The literature on concomitant traumatic brain injury (TBI) and traumatic spinal injury is sparse and a few, if any, studies focus on concomitant TBI and associated upper cervical injury. The objective of this study was to fill this gap and to define demographics, patterns of injury, and clinical data of this specific population. METHODS Records of patients admitted at a single trauma centre with the main diagnosis of TBI and concomitant C0-C1-C2 injury (upper cervical spine) were identified and reviewed. Demographics, clinical, and radiological variables were analyzed and compared to those of patients with TBI and: (i) C3-C7 injury (lower cervical spine); (ii) any other part of the spine other than C1-C2 injury (non-upper cervical); (iii) T1-L5 injury (thoracolumbar). RESULTS 1545 patients were admitted with TBI and an associated C1-C2 injury was found in 22 (1.4%). The mean age was 64 years, and 54.5% were females. Females had a higher rate of concomitant upper cervical injury (p = 0.046 vs non-upper cervical; p = 0.050 vs thoracolumbar). Patients with an upper cervical injury were significantly older (p = 0.034 vs lower cervical; p = 0.030 vs non-upper cervical). Patients older than 55 years old had higher odds of an upper cervical injury when compared to the other groups (OR = 2.75). The main mechanism of trauma was road accidents (RAs) (10/22; 45.5%) All pedestrian injuries occurred in the upper cervical injured group (p = 0.015). ICU length of stay was longer for patients with an upper cervical injury (p = 0.018). Four patients died in the upper cervical injury group (18.2%), and no death occurred in other comparator groups (p = 0.003). CONCLUSIONS The rate of concomitant cranial and upper cervical spine injury was 1.4%. Risk factors were female gender, age ≥ 55, and pedestrians. RAs were the most common mechanism of injury. There was an association between the upper cervical injury group and longer ICU stay as well as higher mortality rates. Increased understanding of the pattern of concomitant craniospinal injury can help guide comprehensive diagnosis, avoid missed injuries, and appropriate treatment.
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Affiliation(s)
- Nicolò Marchesini
- Department of Neurosurgery, University Hospital Borgo Trento, Verona, Italy
| | - Andreas K Demetriades
- Department of Neurosurgery, Royal Infirmary, Edinburgh, UK.
- University Neurosurgical Center Holland, HMC-HAGA The Hague & LUMC, University of Leiden, Leiden, The Netherlands.
| | - Wilco C Peul
- University Neurosurgical Center Holland, HMC-HAGA The Hague & LUMC, University of Leiden, Leiden, The Netherlands
| | - Nicola Tommasi
- Centre of Economic Documentation (CIDE), University of Verona, Verona, Italy
| | - Paolo Zanatta
- Department of Neurocritical Care, University Hospital Borgo Trento, Verona, Italy
| | - Giampietro Pinna
- Department of Neurosurgery, University Hospital Borgo Trento, Verona, Italy
| | - Francesco Sala
- Department of Neurosurgery, University Hospital Borgo Trento, Verona, Italy
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Denchev K, Gomez J, Chen P, Rosenblatt K. Traumatic Brain Injury: Intraoperative Management and Intensive Care Unit Multimodality Monitoring. Anesthesiol Clin 2023; 41:39-78. [PMID: 36872007 DOI: 10.1016/j.anclin.2022.11.003] [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: 03/07/2023]
Abstract
Traumatic brain injury is a devastating event associated with substantial morbidity. Pathophysiology involves the initial trauma, subsequent inflammatory response, and secondary insults, which worsen brain injury severity. Management entails cardiopulmonary stabilization and diagnostic imaging with targeted interventions, such as decompressive hemicraniectomy, intracranial monitors or drains, and pharmacological agents to reduce intracranial pressure. Anesthesia and intensive care requires control of multiple physiologic variables and evidence-based practices to reduce secondary brain injury. Advances in biomedical engineering have enhanced assessments of cerebral oxygenation, pressure, metabolism, blood flow, and autoregulation. Many centers employ multimodality neuromonitoring for targeted therapies with the hope to improve recovery.
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Affiliation(s)
- Krassimir Denchev
- Department of Anesthesiology, Wayne State University, 44555 Woodward Avenue, SJMO Medical Office Building, Suite 308, Pontiac, MI 48341, USA
| | - Jonathan Gomez
- Department of Anesthesiology & Critical Care Medicine, Johns Hopkins University School of Medicine, 600 North Wolfe Street, Phipps 455, Baltimore, MD 21287, USA
| | - Pinxia Chen
- Department of Anesthesiology and Critical Care Medicine, St. Luke's University Health Network, 801 Ostrum Street, Bethlehem, PA 18015, USA
| | - Kathryn Rosenblatt
- Department of Anesthesiology & Critical Care Medicine, Johns Hopkins University School of Medicine, 600 North Wolfe Street, Phipps 455, Baltimore, MD 21287, USA; Department of Neurology, Johns Hopkins University School of Medicine, 600 North Wolfe Street, Phipps 455, Baltimore, MD 21287, USA.
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Carmo GP, Grigioni J, Fernandes FAO, Alves de Sousa RJ. Biomechanics of Traumatic Head and Neck Injuries on Women: A State-of-the-Art Review and Future Directions. BIOLOGY 2023; 12:biology12010083. [PMID: 36671775 PMCID: PMC9855362 DOI: 10.3390/biology12010083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Revised: 12/27/2022] [Accepted: 12/29/2022] [Indexed: 01/06/2023]
Abstract
The biomechanics of traumatic injuries of the human body as a consequence of road crashes, falling, contact sports, and military environments have been studied for decades. In particular, traumatic brain injury (TBI), the so-called "silent epidemic", is the traumatic insult responsible for the greatest percentage of death and disability, justifying the relevance of this research topic. Despite its great importance, only recently have research groups started to seriously consider the sex differences regarding the morphology and physiology of women, which differs from men and may result in a specific outcome for a given traumatic event. This work aims to provide a summary of the contributions given in this field so far, from clinical reports to numerical models, covering not only the direct injuries from inertial loading scenarios but also the role sex plays in the conditions that precede an accident, and post-traumatic events, with an emphasis on neuroendocrine dysfunctions and chronic traumatic encephalopathy. A review on finite element head models and finite element neck models for the study of specific traumatic events is also performed, discussing whether sex was a factor in validating them. Based on the information collected, improvement perspectives and future directions are discussed.
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Affiliation(s)
- Gustavo P. Carmo
- Centre for Mechanical Technology and Automation (TEMA), Department of Mechanical Engineering, Campus Universitário de Santiago, University of Aveiro, 3810-193 Aveiro, Portugal
| | - Jeroen Grigioni
- Centre for Mechanical Technology and Automation (TEMA), Department of Mechanical Engineering, Campus Universitário de Santiago, University of Aveiro, 3810-193 Aveiro, Portugal
| | - Fábio A. O. Fernandes
- Centre for Mechanical Technology and Automation (TEMA), Department of Mechanical Engineering, Campus Universitário de Santiago, University of Aveiro, 3810-193 Aveiro, Portugal
- LASI—Intelligent Systems Associate Laboratory, 4800-058 Guimaraes, Portugal
| | - Ricardo J. Alves de Sousa
- Centre for Mechanical Technology and Automation (TEMA), Department of Mechanical Engineering, Campus Universitário de Santiago, University of Aveiro, 3810-193 Aveiro, Portugal
- LASI—Intelligent Systems Associate Laboratory, 4800-058 Guimaraes, Portugal
- Correspondence: ; Tel.: +351-234-370-200
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van Wessem KJP, Niemeyer MJS, Leenen LPH. Polytrauma patients with severe cervical spine injuries are different than with severe TBI despite similar AIS scores. Sci Rep 2022; 12:21538. [PMID: 36513675 PMCID: PMC9747955 DOI: 10.1038/s41598-022-25809-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Accepted: 12/05/2022] [Indexed: 12/15/2022] Open
Abstract
Traumatic cervical spine injuries (TCSI) are rare injuries. With increasing age the incidence of TCSI is on the rise. TCSI and traumatic brain injury (TBI) are often associated. Both TCSI and TBI are allocated to the Abbreviated Injury Scale (AIS) head region. However, the nature and outcome of these injuries are potentially different. Therefore, the aim of this study was to investigate the epidemiology, demographics and outcome of severely injured patients with severe TCSI, and compare them with polytrauma patients with severe TBI in the strict sense. Consecutive polytrauma patients aged ≥ 15 years with AIShead ≥ 3 who were admitted to a level-1 trauma center Intensive Care Unit (ICU) from 2013 to 2021 were included. Demographics, treatment, and outcome parameters were analyzed for patients who had AIShead ≥ 3 based on TCSI and compared to patients with AIShead ≥ 3 based on proper TBI. Data on follow-up were collected for TCSI patients. Two hundred eighty-four polytrauma patients (68% male, Injury Severity Score (ISS) 33) with AIShead ≥ 3 were included; Thirty-one patients (11%) had AIShead ≥ 3 based on TCSI whereas 253 (89%) had AIShead ≥ 3 based on TBI. TCSI patients had lower systolic blood pressure in the Emergency Department (ED) and stayed longer in ICU than TBI patients. There was no difference in morbidity and mortality rates. TCSI patients died due to high cervical spine injuries or respiratory insufficiency, whereas TBI patients died primarily due to TBI. TCSI was mainly located at C2, and 58% had associated spinal cord injury. Median follow-up time was 22 months. Twenty-two percent had improvement of the spinal cord injury, and 10% died during follow-up. In this study the incidence of severe TCSI in polytrauma was much lower than TBI. Cause of death in TCSI was different compared to TBI demonstrating that AIShead based on TCSI is a different entity than based on TBI. In order to avoid data misinterpretation injuries to the cervical spine should be distinguished from TBI in morbidity and mortality analysis.
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Affiliation(s)
- Karlijn J. P. van Wessem
- grid.7692.a0000000090126352Department of Trauma Surgery, University Medical Center Utrecht, Utrecht, The Netherlands ,grid.7692.a0000000090126352Department of Trauma Surgery, University Medical Center Utrecht, Suite G04.232, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands
| | - Menco J. S. Niemeyer
- grid.7692.a0000000090126352Department of Trauma Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Luke P. H. Leenen
- grid.7692.a0000000090126352Department of Trauma Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
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Urogenital dysfunction following neurotrauma. Curr Opin Neurol 2022; 35:753-760. [PMID: 36367042 DOI: 10.1097/wco.0000000000001122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE OF REVIEW Trauma affecting the nervous system can have widespread consequences, depending on the location and severity of injury. The sensorimotor and cognitive deficits due to neurotrauma have been studied extensively. Although the overall mortality due to neurotrauma has reduced, the disability and morbidity due to neurotrauma has not significantly reduced and focus on urogenital disturbances in these patients has been limited. This article reviews the limited evidence and scientific literature on this topic. RECENT FINDINGS Lower urinary tract symptoms are commonly reported in patients with neurotrauma, both acutely and over the long term. Multiple medical and surgical approaches are available for managing bladder dysfunction in these patients. Sexual dysfunction and changes in sexual behaviour are reported by patients with neurotrauma and are usually multifactorial. Treatment options for sexual dysfunction are available and their management requires a holistic approach. SUMMARY Urogenital dysfunction contributes significantly to the overall functional outcome and impaired quality of life in patients with neurotrauma. A better understanding of the mechanisms behind the urogenital abnormalities is needed for efficient management and treatment.
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Riemann L, Alhalabi OT, Unterberg AW, Younsi A. Concomitant spine trauma in patients with traumatic brain injury: Patient characteristics and outcomes. Front Neurol 2022; 13:861688. [PMID: 36062004 PMCID: PMC9436444 DOI: 10.3389/fneur.2022.861688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Accepted: 06/28/2022] [Indexed: 11/13/2022] Open
Abstract
ObjectiveSpine injury is highly prevalent in patients with poly-trauma, but data on the co-occurrence of spine trauma in patients with traumatic brain injury (TBI) are scarce. In this study, we used the Collaborative European NeuroTrauma Effectiveness Research in Traumatic Brain Injury (CENTER-TBI) database to assess the prevalence, characteristics, and outcomes of patients with TBI and a concurrent traumatic spinal injury (TSI).MethodsData from the European multi-center CENTER-TBI study were analyzed. Adult patients with TBI (≥18 years) presenting with a concomitant, isolated TSI of at least serious severity (Abbreviated Injury Scale; AIS ≥3) were included. For outcome analysis, comparison groups of TBI patients with TSI and systemic injuries (non-isolated TSI) and without TSI were created using propensity score matching. Rates of mortality, unfavorable outcomes (Glasgow Outcome Scale Extended; GOSe < 5), and full recovery (GOSe 7–8) of all patients and separately for patients with only mild TBI (mTBI) were compared between groups at 6-month follow-up.ResultsA total of 164 (4%) of the 4,254 CENTER-TBI core study patients suffered from a concomitant isolated TSI. The median age was 53 [interquartile range (IQR): 37–66] years and 71% of patients were men. mTBI was documented in 62% of cases, followed by severe TBI (26%), and spine injuries were mostly cervical (63%) or thoracic (31%). Surgical spine stabilization was performed in 19% of cases and 57% of patients were admitted to the ICU. Mortality at 6 months was 11% and only 36% of patients regained full recovery. There were no significant differences in the 6-month rates of mortality, unfavorable outcomes, or full recovery between TBI patients with and without concomitant isolated TSI. However, concomitant non-isolated TSI was associated with an unfavorable outcome and a higher mortality. In patients with mTBI, a negative association with full recovery could be observed for both concomitant isolated and non-isolated TSI.ConclusionRates of mortality, unfavorable outcomes, and full recovery in TBI patients with and without concomitant, isolated TSIs were comparable after 6 months. However, in patients with mTBI, concomitant TSI was a negative predictor for a full recovery. These findings might indicate that patients with moderate to severe TBI do not necessarily exhibit worse outcomes when having a concomitant TSI, whereas patients with mTBI might be more affected.
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Hlwatika P, Hardcastle TC. Concurrent cranial and cervical spine injuries by associated injury mechanisms in traumatic brain injury patients. SA J Radiol 2022. [DOI: 10.4102/sajr.v26i2.2321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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Hauser BM, McNulty J, Zaki MM, Gupta S, Cote DJ, Bernstock JD, Lu Y, Chi JH, Groff MW, Khawaja AM, Smith TR, Zaidi HA. Predictors of thoracic and lumbar spine injuries in patients with TBI: A nationwide analysis. Injury 2022; 53:1087-1093. [PMID: 34625238 PMCID: PMC8863622 DOI: 10.1016/j.injury.2021.09.060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Revised: 04/22/2021] [Accepted: 09/26/2021] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Cervical spine injury screening is common practice for traumatic brain injury (TBI) patients. However, risk factors for concomitant thoracolumbar trauma remain unknown. We characterized epidemiology and clinical risk for concomitant thoracolumbar trauma in TBI. METHODS We conducted a multi-center, retrospective cohort analysis of TBI patients in the National Trauma Data Bank from 2011-2014 using multivariable logistic regression. RESULTS Out of 768,718 TBIs, 46,654 (6.1%) and 42,810 (5.6%) patients were diagnosed with thoracic and lumbar spine fractures, respectively. Only 11% of thoracic and 7% of lumbar spine fracture patients had an accompanying spinal cord injury at any level. The most common mechanism of injury was motor vehicle accident (67% of thoracic and 71% and lumbar fractures). Predictors for both thoracic and lumbar fractures included moderate (thoracic: OR 1.26, 95%CI 1.21-1.31; lumbar: OR 1.13, 95%CI 1.08-1.18) and severe Glasgow Coma Scale (GCS) score (OR 1.71, 95%CI 1.67-1.75; OR 1.17, 95%CI 1.13-1.20) compared to mild; epidural hematoma (OR 1.36, 95%CI 1.28-1.44; OR 1.1, 95%CI 1.04-1.19); lower extremity injury (OR 1.38, 95%CI 1.35-1.41; OR 2.50, 95%CI 2.45-2.55); upper extremity injury (OR 2.19, 95%CI 2.14-2.23; OR 1.15, 95%CI 1.13-1.18); smoking (OR 1.09, 95%CI 1.06-1.12; OR 1.12, 95%CI 1.09-1.15); and obesity (OR 1.39, 95%CI 1.34-1.45; OR 1.29, 95%CI 1.24-1.35). Thoracic injuries (OR 4.45; 95% CI 4.35-4.55) predicted lumbar fractures, while abdominal injuries (OR 2.02; 95% CI 1.97-2.07) predicted thoracic fractures. CONCLUSIONS We identified GCS, smoking, upper and lower extremity injuries, and obesity as common risk factors for thoracic and lumbar spinal fractures in TBI.
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Affiliation(s)
- Blake M. Hauser
- Computational Neurosciences Outcomes Center, Department of Neurosurgery, Harvard Medical School, Brigham and Women’s Hospital, Boston, MA
| | - John McNulty
- Computational Neurosciences Outcomes Center, Department of Neurosurgery, Harvard Medical School, Brigham and Women’s Hospital, Boston, MA
| | - Mark M. Zaki
- Computational Neurosciences Outcomes Center, Department of Neurosurgery, Harvard Medical School, Brigham and Women’s Hospital, Boston, MA
| | - Saksham Gupta
- Computational Neurosciences Outcomes Center, Department of Neurosurgery, Harvard Medical School, Brigham and Women’s Hospital, Boston, MA
| | - David J. Cote
- Computational Neurosciences Outcomes Center, Department of Neurosurgery, Harvard Medical School, Brigham and Women’s Hospital, Boston, MA,Channing Division of Network Medicine, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA
| | - Joshua D. Bernstock
- Computational Neurosciences Outcomes Center, Department of Neurosurgery, Harvard Medical School, Brigham and Women’s Hospital, Boston, MA
| | - Yi Lu
- Computational Neurosciences Outcomes Center, Department of Neurosurgery, Harvard Medical School, Brigham and Women’s Hospital, Boston, MA
| | - John H. Chi
- Computational Neurosciences Outcomes Center, Department of Neurosurgery, Harvard Medical School, Brigham and Women’s Hospital, Boston, MA
| | - Michael W. Groff
- Computational Neurosciences Outcomes Center, Department of Neurosurgery, Harvard Medical School, Brigham and Women’s Hospital, Boston, MA
| | - Ayaz M. Khawaja
- Computational Neurosciences Outcomes Center, Department of Neurosurgery, Harvard Medical School, Brigham and Women’s Hospital, Boston, MA
| | - Timothy R. Smith
- Computational Neurosciences Outcomes Center, Department of Neurosurgery, Harvard Medical School, Brigham and Women’s Hospital, Boston, MA
| | - Hasan A. Zaidi
- Computational Neurosciences Outcomes Center, Department of Neurosurgery, Harvard Medical School, Brigham and Women’s Hospital, Boston, MA
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Algahtany MA. Investigating the Association between Orthopedic Fractures and Head Injury due to Road Traffic Accidents. Appl Bionics Biomech 2021; 2021:2430090. [PMID: 34745344 PMCID: PMC8566076 DOI: 10.1155/2021/2430090] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Revised: 10/07/2021] [Accepted: 10/18/2021] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Traumatic head injury (THI) due to road traffic accidents (RTAs) is a global health problem. Studies exploring the association between RTA-related THI and concurrent orthopedic fractures are lacking. We aim to provide a detailed analysis of this association and its impact on inhospital outcomes. METHODS Retrospective analysis of RTA-related THI associated with orthopedic fractures admitted to a large tertiary center, Southwest, Saudi Arabia, over ten years. Descriptive statistics for participant demographics and clinical outcomes were represented by percentages. The associations between head injury diagnosis or orthopedic fractures region and patient demographics are analyzed using the Chi-square test. Post hoc analysis for the significant Chi-square values was carried out by calculating the significant adjusted residuals. Adjust p value was obtained by using the Benjamini-Hochberg procedure to control for multiplicity testing. A p value less than 0.05 was considered statistically significant. RESULTS Concurrent orthopedic fractures are present in one-tenth of RTA-related THI. The cohort was dominated by young males, with 46.5% of the population between 18 and 29 years old. There was a significant association between the head injury diagnosis and the region of orthopedic fracture (p = 0.028). The type of head injury had significant associations with mortality and duration of hospital stay (p = 0.039 and p = 0.037, respectively). The region of orthopedic fracture significantly (p = 0.018) affected the duration of hospital stay, with fractures in the clavicle/shoulder region significantly (p = 0.035) having a short course of hospital admission. CONCLUSION Orthopedic fractures concomitant with RTA-related THI are common. The associations between the two injuries tend to happen in specific patterns. The inhospital stay duration and mortality significantly correlated with the site of the head or orthopedic injury. Knowledge of these patterns improves the care of THI victims, triaging, and resource allocations.
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Affiliation(s)
- Mubarak Ali Algahtany
- Division of Neurosurgery, Department of Surgery, College of Medicine, King Khalid University, Abha, Saudi Arabia
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Comparison of video-stylet and video-laryngoscope for endotracheal intubation in adults with cervical neck immobilisation: A meta-analysis of randomised controlled trials. Anaesth Crit Care Pain Med 2021; 40:100965. [PMID: 34687924 DOI: 10.1016/j.accpm.2021.100965] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Revised: 04/30/2021] [Accepted: 05/16/2021] [Indexed: 12/20/2022]
Abstract
BACKGROUND The efficacy of video-stylet versus video-laryngoscope for tracheal intubation in patients with cervical spine immobilisation, which is known to impede the intubation process, remains unclear. METHODS We searched electronic databases including EMBASE, MEDLINE, Google Scholar, and Cochrane Library for randomised controlled trials comparing video-stylets with video-laryngoscopes in human subjects with cervical spine immobilisation from inception to the 25th of January 2021. The primary outcome was the rate of successful first-attempt intubation, while secondary outcomes included overall intubation success rate, time for successful intubation, and risk of tissue damage. RESULTS Five trials (709 patients) published between 2009 and 2020 met the inclusion criteria. There were four types of video-stylets and three types of video-laryngoscopes examined. Hard cervical collar was applied in four studies, while manual inline stabilisation was used in one study for cervical immobilisation. There was no difference in successful first-attempt intubation rate between the video-stylet and the video-laryngoscope groups [risk ratio (RR) = 0.96, 95% CI: 0.90-1.03, p = 0.3; I2 = 47%] (5 trials, 709 patients). The overall success rate (RR = 0.98, 95% CI: 0.96-1.0, p = 0.05; I2 = 0%), intubation time [mean difference (MD) = 5.24, 95% CI: -8.95 to 19.43, p = 0.47; I2 = 92%], and risk of tissue damage (RR = 0.87, 95% CI: 0.26-2.85, p = 0.81; I2 = 39%) were also comparable between the two groups. CONCLUSIONS This study validates the efficacy of both video-stylets and video-laryngoscopes for tracheal intubation in the situation of cervical spine immobilisation. Further large-scale trials are warranted to support our findings in this clinical setting.
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Vedin T, Bergenfeldt H, Holmström E, Lundager-Forberg J, Edelhamre M. Microwave scan and brain biomarkers to rule out intracranial hemorrhage: study protocol of a planned prospective study (MBI01). Eur J Trauma Emerg Surg 2021; 48:1335-1342. [PMID: 33944977 PMCID: PMC9001545 DOI: 10.1007/s00068-021-01671-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2021] [Accepted: 04/12/2021] [Indexed: 11/25/2022]
Abstract
Purpose The aim of this planned study is to evaluate the ability of a cranial microwave scanner in conjunction with nine brain biomarkers (Aβ40, Aβ42, GFAP, H-FABP, S100B, NF-L, NSE, UCH-L1 and IL-10) to detect and rule out traumatic intracranial hemorrhage in an emergency department setting. Traumatic brain injury is a world-wide topic of interest for researchers and clinicians. It affects 2% of the population per annum and presents challenges for physicians as patients’ initial signs and symptoms do not always correlate with the extent of brain injury. The gold standard for diagnosis of intracranial hemorrhage is head computerized tomography (CT) with the drawbacks of high cost and radiation exposure. A fast, secure way of diagnosing without these drawbacks has potential to make care more effective and reduce cost. Methods Study will be prospective and enroll adult, consenting patients with head trauma who seek emergency department care. Only patients where the treating physician prescribes a head-CT will be included. The microwave scan and blood sampling will be performed in close temporal proximity to the CT scan. Results will be analyzed with sensitivity, specificity and receiver operator characteristics analysis to provide the best combination of a number of biomarkers and the microwave scan. Conclusion This study will explore the diagnostic accuracy of a head microwave scanner in combination with biomarkers in ruling out intracranial hemorrhage in traumatic brain injury patients presenting to the emergency department. Potentially, this combined diagnostic approach could achieve both high sensitivity and high specificity, thereby reducing the need of CT-head scans when managing these patients. Clinicaltrials.gov identifier: NCT04666766. Registered December 11, 2020.
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Affiliation(s)
- Tomas Vedin
- Clinical Sciences, Lund University, Svartbrödragränden 3-5, 251 87 Helsingborg, Sweden
| | - Henrik Bergenfeldt
- Clinical Sciences, Lund University, Svartbrödragränden 3-5, 251 87 Helsingborg, Sweden
| | - Emanuel Holmström
- Clinical Sciences, Lund University, Svartbrödragränden 3-5, 251 87 Helsingborg, Sweden
| | | | - Marcus Edelhamre
- Clinical Sciences, Lund University, Svartbrödragränden 3-5, 251 87 Helsingborg, Sweden
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Alberto EC, Harvey AR, Amberson MJ, Zheng Y, Thenappan AA, Oluigbo C, Marsic I, Sarcevic A, O'Connell KJ, Burd RS. Assessment of Non-Routine Events and Significant Physiological Disturbances during Emergency Department Evaluation after Pediatric Head Trauma. Neurotrauma Rep 2021; 2:39-47. [PMID: 33748812 PMCID: PMC7962792 DOI: 10.1089/neur.2020.0043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Outcomes following pediatric traumatic brain injury (TBI) are dependent on initial injury severity and prevention of secondary injury. Hypoxia, hypotension, and hyperventilation following TBI are associated with increased mortality. The purpose of this study was to determine the association of non-routine events (NREs) during the initial resuscitation phase with these physiological disturbances. We conducted a video review of pediatric trauma resuscitations of patients with suspected TBI and Glasgow Coma Scale (GCS) scores <13. NREs were rated as "momentary" if task progression was delayed by <1 min and "moderate" if delayed by >1 min. Vital sign monitor data were used to identify periods of significant physiological disturbances. We calculated the association between the rate of overall and moderate NREs per case and the proportion of cases with abnormal vital signs using multi-variate linear regression, controlling for GCS score and need for intubation. Among 26 resuscitations, 604 NREs were identified with a median of 23 (interquartile range [IQR] 17-27.8, range 5-44) per case. Moderate delay NREs occurred in 19 resuscitations (n = 32, median 1 NRE/resuscitation, IQR 0.3-1, range 0-5). Oxygen desaturation and respiratory depression were associated with a greater rate of moderate NREs (p = 0.008, p < 0.001, respectively). We observed no association between duration of hypotension, desaturation, and respiratory depression and overall NRE rate. NREs are common in the initial resuscitation of children with moderate to severe TBI. Episodes of hypoxia and respiratory depression are associated with NREs that cause a moderate delay in task progression. Conformance with resuscitation guidelines is needed to prevent physiological events associated with adverse outcomes following pediatric TBI.
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Affiliation(s)
- Emily C. Alberto
- Division of Trauma and Burn Surgery, Children's National Hospital, Washington DC, USA
| | - Allison R. Harvey
- Division of Trauma and Burn Surgery, Children's National Hospital, Washington DC, USA
| | | | - Yinan Zheng
- Division of Trauma and Burn Surgery, Children's National Hospital, Washington DC, USA
| | | | - Chima Oluigbo
- Division of Neurosurgery, Children's National Hospital, Washington DC, USA
| | - Ivan Marsic
- Department of Electrical and Computer Engineering, Rutgers University, Piscataway, New Jersey, USA
| | - Aleksandra Sarcevic
- College of Computing and Informatics, Drexel University, Philadelphia, Pennsylvania, USA
| | - Karen J. O'Connell
- Division of Emergency Medicine, Children's National Hospital, Washington DC, USA
| | - Randall S. Burd
- Division of Trauma and Burn Surgery, Children's National Hospital, Washington DC, USA
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14
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Malale ML, Dufourq N, Parag N. A profile of traumatic brain injuries and associated cervical spine injuries at a regional hospital in the KwaZulu-Natal Province. S Afr Fam Pract (2004) 2020; 62:e1-e6. [PMID: 33054251 PMCID: PMC8377772 DOI: 10.4102/safp.v62i1.5136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 07/30/2020] [Accepted: 08/07/2020] [Indexed: 11/03/2022] Open
Abstract
Background Clearing the cervical spine in an unconscious blunt trauma patient is an elusive concept. The aim of this study was to describe the incidence of cervical spine injury (CSI) in patients with a traumatic brain injury (TBI). The study was conducted on patients who underwent imaging of both the cervical spine and the brain in one sitting at a busy government healthcare facility in Pietermaritzburg. Methods This was a retrospective, cross sectional study of all the trauma patients presenting to a regional hospital emergency department (ED) in the KwaZulu-Natal (KZN) Province, who underwent computed tomography (CT) imaging of the brain and the cervical spine in one sitting during the period January 2016 to June 2016. Results Adult males formed the majority (78.9%) of the study population and had the highest incidence of TBI, the most common identified pathology in CT being parenchymal injuries (41%). The mechanisms that resulted in the majority of injuries sustained were assault (38.7%) and motor vehicle collisions (MVCs) (25%), while seven patients (4.76%) had a combined diagnosis of TBI and CSI. The average Glasgow Coma Scale (GCS) was 12. Conclusion Young adult males are at the greatest risk of sustaining TBI, with assault being the most common mechanism of injury. Combined diagnoses of TBI and CSI are rare and were mostly noted in patients involved in MVCs and pedestrian vehicle collisions. While the chance of an abnormal CT scan increased with a decreasing GCS score, 33% of patients with a mild TBI did not have abnormal CT findings, and 25% patients with severe TBI had no abnormal CT findings.
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Affiliation(s)
- Maamei L Malale
- Department of Emergency Medicine, Nelson Rolihlahla School of Medicine, University of KwaZulu-Natal, Empangeni.
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Sutton M, Chan V, Escobar M, Mollayeva T, Hu Z, Colantonio A. Neck Injury Comorbidity in Concussion-Related Emergency Department Visits: A Population-Based Study of Sex Differences Across the Life Span. J Womens Health (Larchmt) 2018; 28:473-482. [PMID: 30592685 PMCID: PMC6482894 DOI: 10.1089/jwh.2018.7282] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Background: The cervical spine region can be especially vulnerable to concurrent injury in concussion, with research suggesting that females may be at greater risk due to their weaker and anatomically distinct necks. The main objective of our research was to study sex differences in the rate of neck injury comorbidity across the life span among patients with a concussion diagnosis in the emergency department (ED) setting, by cause of injury (motor vehicle collisions [MVC] and sports). Materials and Methods: All patients with a first concussion-related ED visit between fiscal years 2002/2003 and 2011/2012 (inclusive) in Ontario were identified in population-based health administrative data using the International Statistical Classification of Diseases and Related Health Problems, Tenth Revision, Canada (ICD-10-CA) codes. Age-dependent odds ratios of comorbid neck injury for sex were estimated using polynomial multivariable logistic regression models, adjusting for sociodemographic characteristics. Results: Females with a concussion had significantly higher odds of sustaining a comorbid neck injury between the ages of 5–49 years for all concussion-related ED visits, 15–49 years for MVC-related concussion ED visits, and 10–39 years for sports-related concussion ED visits, holding all other covariates in the model constant. Conclusions: These results support the consideration of increased screening for comorbid neck injuries, particularly for females, to allow for early intervention. Furthermore, the increased risk of comorbid neck injury in females with a concussion-related ED visit was age-dependent, with the interaction between sex and age following a nonlinear trend. As such, future studies on concussions should consider linear and nonlinear sex and age interactions.
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Affiliation(s)
- Mitchell Sutton
- Toronto Rehabilitation Institute–University Health Network, Toronto, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Vincy Chan
- Toronto Rehabilitation Institute–University Health Network, Toronto, Canada
| | - Michael Escobar
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Tatyana Mollayeva
- Toronto Rehabilitation Institute–University Health Network, Toronto, Canada
- Department of Occupational Sciences and Occupational Therapy, University of Toronto, Toronto, Canada
| | - Zheng Hu
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Angela Colantonio
- Toronto Rehabilitation Institute–University Health Network, Toronto, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
- Department of Occupational Sciences and Occupational Therapy, University of Toronto, Toronto, Canada
- Rehabilitation Sciences Institute, University of Toronto, Toronto, Canada
- Institute for Clinical and Evaluative Sciences, Toronto, Canada
- Address correspondence to: Angela Colantonio, PhD, Rehabilitation Sciences Building, University of Toronto, 500 University Avenue, Suite 160, Toronto, ON M5G 1V7, Canada
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Prevalence of concomitant traumatic cranio-spinal injury: a systematic review and meta-analysis. Neurosurg Rev 2018; 43:69-77. [PMID: 29882173 PMCID: PMC7010651 DOI: 10.1007/s10143-018-0988-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2018] [Revised: 05/12/2018] [Accepted: 05/28/2018] [Indexed: 10/28/2022]
Abstract
The biomechanical relationship between cranial and spinal structures makes concomitant injury likely. Concomitant cranio-spinal injuries are important to consider following trauma due to the serious consequences of a missed injury. The objective of this review was to estimate the prevalence of concomitant cranio-spinal injury in the adult trauma population. A systematic search of MEDLINE and EMBASE databases to identify observational studies reporting the prevalence of concomitant cranio-spinal injury in the general adult trauma population was conducted on 21 March 2017. The prevalence of concomitant cervical spinal injury in patients with a traumatic brain injury (TBI); the prevalence of concomitant spinal injury in patients with a TBI; the prevalence of concomitant TBI in patients with a cervical spinal injury; and the prevalence of concomitant TBI in patients with a spinal injury were calculated by meta-analysis. Twenty-one studies met the inclusion criteria and were included in this review. The prevalence of concomitant cervical spinal injury in patients with a TBI was found to be 6.5% (95% CI 6.0-7.1%); the prevalence of concomitant spinal injury in patients with a TBI to be 12.4-12.5%; the prevalence of concomitant TBI in patients with a cervical spinal injury to be 40.4% (95% CI 33.0-48.0%); and the prevalence of concomitant TBI in patients with a spinal injury to be 32.5% (95% CI 10.8-59.3%). This review reports the prevalence of concomitant cranio-spinal injury and highlights the importance of considering concomitant injury in patients with a cranial or spinal traumatic injury.
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Head injuries and the risk of concurrent cervical spine fractures. Acta Neurochir (Wien) 2017; 159:907-914. [PMID: 28258310 DOI: 10.1007/s00701-017-3133-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2016] [Accepted: 02/20/2017] [Indexed: 10/20/2022]
Abstract
BACKGROUND Cervical spine injuries of variable severity are common among patients with an acute traumatic brain injury (TBI). We hypothesised that TBI patients with positive head computed tomography (CT) scans would have a significantly higher risk of having an associated cervical spine fracture compared to patients with negative head CT scans. METHOD This widely generalisable retrospective sample was derived from 3,023 consecutive patients, who, due to an acute head injury (HI), underwent head CT at the Emergency Department of Tampere University Hospital (August 2010-July 2012). Medical records were reviewed to identify the individuals whose cervical spine was CT-imaged within 1 week after primary head CT due to a clinical suspicion of a cervical spine injury (CSI) (n = 1,091). RESULTS Of the whole cranio-cervically CT-imaged sample (n = 1,091), 24.7% (n = 269) had an acute CT-positive TBI. Car accidents 22.4% (n = 244) and falls 47.8% (n = 521) were the most frequent injury mechanisms. On cervical CT, any type of fracture was found in 6.6% (n = 72) and dislocation and/or subluxation in 2.8% (n = 31) of the patients. The patients with acute traumatic intracranial lesions had significantly (p = 0.04; OR = 1.689) more cervical spine fractures (9.3%, n = 25) compared to head CT-negative patients (5.7%, n = 47). On an individual cervical column level, head CT positivity was especially related to C6 fractures (p = 0.031, OR = 2.769). Patients with cervical spine fractures (n = 72) had altogether 101 fractured vertebrae, which were most often C2 (22.8, n = 23), C7 (19.8%, n = 20) and C6 (16.8%, n = 17). CONCLUSIONS Head trauma patients with acute intracranial lesions on CT have a higher risk for cervical spine fractures in comparison to patients with a CT-negative head injury. Although statistically significant, the difference in fracture rate was small. However, based on these results, we suggest that cervical spine fractures should be acknowledged when treating CT-positive TBIs.
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Abstract
OBJECT In the US, race and economic status have pervasive associations with mechanisms of injury, severity of injury, management, and outcomes of trauma. The goal of the current study was to examine these relationships on a large scale in the setting of pediatric spinal injury. METHODS Admissions for spinal fracture without or with spinal cord injury (SCI), spinal dislocation, and SCI without radiographic abnormality were identified in the Kids' Inpatient Database (KID) and the National Trauma Data Bank (NTDB) registry for 2009. Patients ranged in age from birth up to 21 years. Data from the KID were used to estimate nationwide annual incidences. Data from the NTDB were used to describe patterns of injury in relation to age, race, and payor, with corroboration from the KID. Multiple logistic regression was used to model rates of mortality and spinal fusion. RESULTS In 2009, the estimated incidence of hospital admission for spinal injury in the US was 170 per 1 million in the population under 21 years of age. The incidence of SCI was 24 per 1 million. Incidences varied regionally. Adolescents predominated. Patterns of injury varied by age, race, and payor. Black patients were more severely injured than patients of other races as measured by Injury Severity Scale scores. Among black patients with spinal injury in the NTDB, 23.9% suffered firearm injuries; only 1% of white patients suffered firearm injuries. The overall mortality rate in the NTDB was 3.9%. In a multivariate analysis that included a large panel of clinical and nonclinical factors, black race retained significance as a predictor of mortality (p = 0.006; adjusted OR 1.571 [1.141-2.163]). Rates of spinal fusion were associated with race and payor in the NTDB data and with payor in the KID: patients with better insurance underwent spinal fusion at higher rates. CONCLUSIONS The epidemiology of pediatric spinal injury in the US cannot be understood apart from considerations of race and economic status.
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Affiliation(s)
- Joseph H Piatt
- Nemours Neuroscience Center, AI duPont Hospital for Children, Wilmington, Delaware; and Departments of Neurological Surgery and Pediatrics, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania
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Mukherjee S, Abhinav K, Revington PJ. A review of cervical spine injury associated with maxillofacial trauma at a UK tertiary referral centre. Ann R Coll Surg Engl 2015; 97:66-72. [PMID: 25519271 PMCID: PMC4473904 DOI: 10.1308/003588414x14055925059633] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/29/2014] [Indexed: 12/21/2022] Open
Abstract
INTRODUCTION The aim of this study was to determine the incidence and patterns of cervical spine injury (CSI) associated with maxillofacial fractures at a UK trauma centre. METHODS A retrospective analysis was conducted of 714 maxillofacial fracture patients presenting to a single trauma centre between 2006 and 2012. RESULTS Of the 714 maxillofacial fracture patients, 2.2% had associated CSI including a fracture, cord contusion or disc herniation. In comparison, 1.0% of patients without maxillofacial trauma sustained a CSI (odds ratio: 2.2, p=0.01). The majority (88%) of CSI cases of were caused by a road traffic accident (RTA) with the remainder due to falls. While 8.8% of RTA related maxillofacial trauma patients sustained a CSI, only 2.0% of fall related patients did (p=0.03, not significant). Most (70%) of the CSIs occurred at C1/C2 or C6/C7 levels. Overall, 455, 220 and 39 patients suffered non-mandibular, isolated mandibular and mixed mandibular/non-mandibular fractures respectively. Their respective incidences of CSI were 1.5%, 1.8% and 12.8% (p=0.005, significant). Twelve patients with concomitant CSI had their maxillofacial fractures treated within twenty-four hours and all were treated within four days. CONCLUSIONS The presence of maxillofacial trauma mandates exclusion and prompt management of cervical spine injury, particularly in RTA and trauma cases involving combined facial fracture patterns. This approach will facilitate management of maxillofacial fractures within an optimum time period.
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