ORIGINAL CONTRIBUTION cervical spine, fracture, occult; fracture, cervical spine, occult; spine, cervical, fracture Clinical Presentation of Patients with Acute Cervical Spine Injury James Walter, MD* A retrospective review of 67 patients with acute cervical spine fracture and/ Peter E Doris, MD*I¢** or dislocation was conducted at two suburban community hospital emer- Mark A Shaffer, MD*§ gency departments. The mean age was 39, and two-thirds of the patients Chicago were male. Motor vehicle accidents and falls accounted for more than 80% of all injuries. On emergency department evaluation, it was found that there From the Departments of Emergency was no history of loss of consciousness in 42 patients (63%), no associated Medicine* and Radiology, t University of crania-facial injuries in 31 patients (46%), and a normal sensorimotor exam- Chicago Hospitals and Clinics, Chicago; ination in 59 patients (88%). Thirty-four patients (50%) were evaluated for the Department of Radiology, St James cervical range of motion, which was found to be normal in one-third of the Hospital,¢ Chicago Heights; the cases. The absence of mental status changes, crania-facial injuries, range of Department of Radiology, Edward motion abnormalities, and focal neurological findings is, therefore, not un- Hospital,** Naperville; and the Department common in patients who have sustained cervical spine injury. [Walter J, of Emergency Medicine, Hinsdale Hospital,§ Hinsdale, Illinois. Doris PE, Shaffer MA: Clinical presentation of patients with acute cervical spine injury. Ann Emerg Med July 1984;13:512-515.] Presented at the University Association for Emergency Medicine Annual Meeting in INTRODUCTION Salt Lake City, April 1982. Published studies on cervical spine injury for the most part have cited data derived from experience in tertiary care centers. These studies have concen- Received for publication October 18, trated on patients with injury to the cervical cord, detailing the types of 1982. Revision received July 20, 1983. associated cervical spine lesions, reviewing the mechanics of physical disrup- Accepted for publication December 1, tion of the cervical spine, and describing the neurological sequelae seen with 1983. cervical trauma. Controversies in treatment have received extensive discus- sion. 1~4 Address for reprints: James Walter, MD, Such data, however, may not be entirely applicable to emergency practice. Department of Emergency Medicine, In fact, the population bias of available studies may have led to significant University of Chicago Hospitals and Clinics, Box 488, 950 East 59th Street, distortions in our understanding of the clinical presentation of patients seen Chicago, Illinois 60637. in primary care facilities with an acute cervical spine lesion. Our study is a retrospective analysis of a series of patients who were evalu- ated in the emergency departments of two suburban community hospitals and diagnosed as having sustained acute cervical spine fracture and/or dis- location. The patient population and etiology of injury are described. Special attention is given to the clinical presentation of these patients. MATERIALS AND METHODS The charts of 67 patients with a hospital discharge diagnosis of cervical spine fracture and/or dislocation were reviewed retrospectively. These pa- tients were evaluated and treated from 1977 through 1980 at two suburban community hospitals located approximately 30 miles from Chicago. The emergency departments of the two hospitals have a combined volume of 60,000 visits per year. The patients' emergency department and hospital charts were analyzed retrospectively for age, sex, and etiologic event. Presenting symptoms were determined by reviewing information offered spontaneously by the patient or elicited in questioning by the triage officer and the examining physician. The physician's initial examination was reviewed carefully, with particular atten- tion to data regarding mental status, neck tenderness, cervical range of mo- tion, neurological findings, and associated injuries. If necessary, additional information concerning physical findings was obtained from the triage of- ficer's notes and the consulting physician's summary. The results of all radio- 13:7 July 1984 Annals of Emergency Medicine 512/39
ACUTE CERVICAL SPINE INJURY Walter, Doris & Shaffer TABLE 1. Cervical spine injuries in the 12 patients with no documented complaints of neck pain or stiffness on presentation Age (y)/ Mental Status Sex (M/F) Etiology Lesion Changes Associated Injuries Additional Comments 45/M MVA Fracture of odontoid Injury missed on initial presentation after MVA. Returned 3 weeks later with hemorrhagic gastritis. Began complaining of neck pain several days after admission. 63/M EtOH Unknown/h/o Fracture body C2 seizures 43/M MVA Avulsion anterior/ Did not recall Rib fractures, Pain elicited on palpation inferior aspect C2 fracture right femur, forehead laceration 29/M MVA Avulsion anterior/ EtOH Multiple abrasions/ lacerations/ inferior aspect C2 contusions 59/M Fall Anterior compression Compression Pain elicited on palpation fracture C7 fractures T8 and Tlo 61/F MVA Fracture spinous Forehead Pain elicited on palpation laceration process 0 7 23/M MVA Anterior subluxation EtOH, h/o Wrist fracture, 4 h after presentation developed T1 loss of scalp laceration sensory/motor level C5 on C6, fracture posterior elements conciousness C5 and C6, fracture lateral mass C7, anterior subluxation C 7 on T1 Right frontal Full range of cervical motion. C-spine 32/F MVA Posterior subluxation C2 on C3 hematoma initially read as negative. Complained of neck stiffness the following day when called back to ED 40/M MVA Anterior subluxation ? loss of Multiple Full range of cervical motion, consciousness lacerations/ neurological deficit right C5/C6 C5 on C6, fracture contusions distribution posterior element C6 21/M Pedestrian Avulsion fracture h/o loss of Left pulmonary Full range of cervical motion contusion, multiple hit by motor anterior/inferior consciousness, incoherent abrasions vehicle aspect C6 Pelvic fracture, Pain elicited on palpation 14/M MVA Posterior subluxation C2 on C3, fracture right compression fracture clavicle C6 36/M MVA Hangman's fracture, h/o loss of Splenic rupture, Fracture body C consciousness renal injury, large scalp flap, Multiple abrasions graphic studies of the cervical spine logic in 45 patients (70%). Falls static to the cervical spine sustained a were recorded and classified according accounted for the injury in eight pa- fall and presented with neck pain of to distribution and probable mecha- tients (12%). Five patients (7%)suf- four days duration. One patient was nism of injurg. fered sports-related trauma, three div- status post cervical laminect0my and ing into shallow water, one attempting fusion with a recent increase in neck RESULTS a back flip, and one hitting his head pain. Of the 67 patients with acute cer- on the backboard while playing bas- Analysis of the clinical presenta- vical spine injury, 45 (67%) were male. ketball. Three patients (4%) were pe- tions of this series of patients revealed The mean age was 39. Sixty percent of destrians hit by a motor vehicle. In that 42 patients (63%) presented with- the injuries occurred in patients be- two inebriated patients, there was no out a history of loss of consciousness. tween 21 and 50 years of age. obvious history or signs of trauma. Four patients (6%) had an equivocal Motor vehicle accidents were etio- One patient with breast cancer meta- history with regard to loss of con- 40/513 Annals of Emergency Medicine 13: 7. July 1984
Recommend
More recommend
