Clearing the cervical spine in obtunded patients.
Clearing the cervical spine in obtunded patients.
复制标题
清理迟钝患者的颈椎。
DOI：
10.1097/brs.0b013e31817926c1
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发表时间：
2008
期刊：
影响因子：
3
通讯作者：
Jurkovich,GregoryJ
中科院分区：
文献类型：
--
作者：
Harris,TylerJ;Blackmore,CCraig;Mirza,SohailK;Jurkovich,GregoryJ
研究设计：回顾队列研究。目的：确定闭合性闭合性创伤患者颈椎初始CT检查漏诊损伤的频率。背景数据概述。排除闭合性创伤患者颈椎损伤的最佳方法仍然存在争议。创伤中心在脊柱清除方案上表现出明显的差异。方法：我们回顾了连续两年在一级创伤中心入院的闭合性钝性创伤患者的医疗记录，并选择了在最初的急诊室评估中进行颈椎CT成像的患者。我们排除了这项研究确定了损伤的患者，以及按照机构方案的要求，在随后用直立颈椎X线片进行成像之前可以进行检查的患者。使用出院时通过后续影像或临床检查诊断的颈椎损伤的综合参考标准，我们评估了首次CT遗漏的损伤的频率和类型以及由于额外成像而导致的脊柱清除延迟。结果：在590名筛选的患者中，367人符合纳入和排除标准。研究队列的平均年龄为40.2岁(SD 20.8)，其中75.5%为男性，平均格拉斯哥昏迷评分5.9(SD 3.4)，平均损伤严重程度评分24.5(SD 10)。最初的CT成像未能发现1例损伤，假阴性率为0.3%(1/367)：颈髓挫伤在随后的体检中被发现，经磁共振成像证实，并经非手术治疗。直立颈椎X线片没有发现CT遗漏的任何损伤，但在42%的患者中，它们平均延迟了2.6天和超过48小时的脊柱清除。结论：初步的CT成像发现了闭合性创伤患者中所有不稳定的颈椎损伤。随后的直立X线片没有发现任何额外的损伤，但明显延迟了脊柱清除。
Study Design.Retrospective cohort study.Objective.To determine the frequency of injuries missed by initial computed tomography (CT) of the cervical spine in obtunded blunt trauma victims.Summary of Background Data.Optimal method for excluding cervical spine injury in obtunded trauma patients remains controversial. Trauma centers show marked variation in spine clearance protocols.Methods.We reviewed medical records of consecutive obtunded blunt trauma victims admitted over 2 years to a level 1 trauma center and selected patients who had CT imaging of the cervical spine during their initial emergency room evaluation. We excluded patients in whom this study identified an injury and also patients who became examinable before subsequent imaging with upright cervical spine radiographs, as required by institutional protocol. Using composite reference standard of cervical injury diagnosed by subsequent imaging or clinical examinations by the time of discharge from the hospital, we evaluated the frequency and type of injuries missed by the initial CT and the delay in spine clearance due to additional imaging.Results.Of 590 screened patients, 367 met the inclusion and exclusion criteria. The study cohort had mean age 40.2 years (SD 20.8), 75.5% males, mean Glasgow Coma Scale score 5.9 (SD 3.4), and mean Injury Severity Scale score 24.5 (SD 10). Initial CT imaging failed to identify an injury in 1 patient, for a false negative rate of 0.3%(1/367): a cervical cord contusion identified on subsequent physical examination, confirmed by magnetic resonance imaging, and managed nonoperatively. Upright cervical spine radiographs did not identify any injuries missed by CT, but they delayed spine clearance by a mean of 2.6 days and by more than 48 hours in 42% of the patients.Conclusion.Initial CT imaging identified all unstable cervical spine injuries in obtunded trauma patients. Subsequent upright radiographs did not identify any additional injuries but significantly delayed spine clearance.