A profile of traumatic brain injuries and associated cervical spine injuries at a regional hospital in the KwaZulu-Natal Province

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.

Clearing the Spine in the Unconscious Trauma Patient: An Update

Clearing the spine of the unconscious traumatised patient is a task that the intensive care clinician faces frequently. Technological advances in cross-sectional imaging are such that the cervical and thoraco-lumbar spine can now be cleared quickly and reliably in a single computerised tomography imaging session, which all trauma patients require, with no extra exposure to radiation. This results in less patient manipulation and should reduce the time to cessation of unnecessary spinal precautions which themselves can lead to patient harm. Such head-to-toe inclusive ‘traumagrams’ are the standard of care received by casualties presenting at western military medical facilities in Afghanistan.