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Jamshaid S, Rotimi O, Tanna R, Elmiyeh B. Complicated penetrating foreign body neck injury. BMJ Case Rep 2024; 17:e259396. [PMID: 38677718 PMCID: PMC11057282 DOI: 10.1136/bcr-2023-259396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/29/2024] Open
Abstract
Penetrating neck injury is associated with significant morbidity due to the several structures (neurological, vascular and aerodigestive) within close proximity to one another. This case highlights an uncommon presentation of an embedded foreign body following penetrating neck trauma and the decision-making required during management.
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Chandrananth ML, Lee JD, Read D, Shakerian R. 'No zone' approach in the management of penetrating neck injuries - an Australian Tertiary Trauma Centre experience. ANZ J Surg 2024; 94:591-596. [PMID: 38525869 DOI: 10.1111/ans.18939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Revised: 01/20/2024] [Accepted: 02/27/2024] [Indexed: 03/26/2024]
Abstract
PURPOSE Penetrating neck injuries (PNIs), defined as deep to the platysma, can result in significant morbidity and mortality. Management has evolved from a zone-based approach to a 'no zone' algorithm, resulting in reduced non-therapeutic neck exploration rates. The aim of this study was to examine PNIs and its management trends in an Australian tertiary trauma centre, to determine if a 'no zone' approach could be safely implemented in this population, as has been demonstrated internationally. METHODOLOGY This was a retrospective observational study at a level 1 adult Australian tertiary trauma centre using prospectively collated data from January 2008 to December 2018. Observed data included age, gender, mechanism of injury, computed tomography angiography (CT-A) use and operative intervention. Patients were examined based on zone of injury and presenting signs - 'hard', 'soft' or 'asymptomatic'. Major outcomes were CT-A usage, positive CT-A correlation with therapeutic neck explorations and negative neck exploration rates. RESULTS This study identified 238 PNI patients, with 204 selected for review. Most injuries occurred in zone 2 (71.6%), with soft signs accounting for 53.4% of cases. Over 10 years, CT-A utilization increased from 55% to 94.1%, with positive CT-As being more likely to yield therapeutic neck explorations. There was a general decreased trend in operative intervention but without a clear reduction in non-therapeutic neck explorations. CONCLUSION Our data suggests similarities with results from around the world, demonstrating that the 'no zone' approach should be considered when managing PNIs, but with clinician discretion in individual cases.
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Affiliation(s)
- Meera L Chandrananth
- Department of General Surgical Specialties, The Royal Melbourne Hospital, Parkville, Victoria, Australia
- Trauma Service, The Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - Jordan D Lee
- Department of General Surgical Specialties, The Royal Melbourne Hospital, Parkville, Victoria, Australia
- Trauma Service, The Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - David Read
- Department of General Surgical Specialties, The Royal Melbourne Hospital, Parkville, Victoria, Australia
- Trauma Service, The Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - Rose Shakerian
- Department of General Surgical Specialties, The Royal Melbourne Hospital, Parkville, Victoria, Australia
- Trauma Service, The Royal Melbourne Hospital, Parkville, Victoria, Australia
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Wang AP, Hernandez ST, Kaderali Z, Heran N, Erdenebold UE, Fahed R, Walker GB. Clinical Reasoning: A 24-Year-Old Woman With Penetrating Neck Injury From a Needlefish. Neurology 2024; 102:e209225. [PMID: 38377451 DOI: 10.1212/wnl.0000000000209225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Accepted: 01/16/2024] [Indexed: 02/22/2024] Open
Abstract
Evaluating patients with a traumatic spinal cord injury can be complicated by other injuries. In this case, a 24-year-old woman injured by a needlefish presented with combined motor and sensory defects, cranial nerve deficits, and a blunt vascular injury. This case highlights the importance of neurologic and vascular localizations and an understanding of spinal cord injuries involving various ascending and descending tracts. Appreciation of these anatomical considerations through this case illustrates the diagnostic approach to neurologic evaluation. While we present a traumatic etiology for multiple neurologic syndromes, this case gives readers an opportunity to develop a comprehensive differential diagnosis and tailor investigations for other relevant etiologies. Readers walking through this stepwise process will ultimately arrive at several distinct but related diagnoses.
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Affiliation(s)
- Alick P Wang
- From the Division of Neurosurgery (A.P.W.), Department of Surgery, University of Ottawa, The Ottawa Hospital; Faculty of Kinesiology (S.T.H.), University of Toronto; Division of Neurosurgery (Z.K., N.H.), Department of Surgery, University of British Columbia, Royal Columbian Hospital, New Westminster; Department of Diagnostic Radiology (U.-E.E.), Dalhousie University, QEII Health Sciences Centre, Halifax; Division of Neurology (R.F.), Department of Medicine, University of Ottawa, The Ottawa Hospital; and Division of Neurology (G.B.W.), Department of Medicine, University of British Columbia, Royal Columbian Hospital, New Westminster, Canada
| | - Sean T Hernandez
- From the Division of Neurosurgery (A.P.W.), Department of Surgery, University of Ottawa, The Ottawa Hospital; Faculty of Kinesiology (S.T.H.), University of Toronto; Division of Neurosurgery (Z.K., N.H.), Department of Surgery, University of British Columbia, Royal Columbian Hospital, New Westminster; Department of Diagnostic Radiology (U.-E.E.), Dalhousie University, QEII Health Sciences Centre, Halifax; Division of Neurology (R.F.), Department of Medicine, University of Ottawa, The Ottawa Hospital; and Division of Neurology (G.B.W.), Department of Medicine, University of British Columbia, Royal Columbian Hospital, New Westminster, Canada
| | - Zul Kaderali
- From the Division of Neurosurgery (A.P.W.), Department of Surgery, University of Ottawa, The Ottawa Hospital; Faculty of Kinesiology (S.T.H.), University of Toronto; Division of Neurosurgery (Z.K., N.H.), Department of Surgery, University of British Columbia, Royal Columbian Hospital, New Westminster; Department of Diagnostic Radiology (U.-E.E.), Dalhousie University, QEII Health Sciences Centre, Halifax; Division of Neurology (R.F.), Department of Medicine, University of Ottawa, The Ottawa Hospital; and Division of Neurology (G.B.W.), Department of Medicine, University of British Columbia, Royal Columbian Hospital, New Westminster, Canada
| | - Navraj Heran
- From the Division of Neurosurgery (A.P.W.), Department of Surgery, University of Ottawa, The Ottawa Hospital; Faculty of Kinesiology (S.T.H.), University of Toronto; Division of Neurosurgery (Z.K., N.H.), Department of Surgery, University of British Columbia, Royal Columbian Hospital, New Westminster; Department of Diagnostic Radiology (U.-E.E.), Dalhousie University, QEII Health Sciences Centre, Halifax; Division of Neurology (R.F.), Department of Medicine, University of Ottawa, The Ottawa Hospital; and Division of Neurology (G.B.W.), Department of Medicine, University of British Columbia, Royal Columbian Hospital, New Westminster, Canada
| | - Undrakh-Erdene Erdenebold
- From the Division of Neurosurgery (A.P.W.), Department of Surgery, University of Ottawa, The Ottawa Hospital; Faculty of Kinesiology (S.T.H.), University of Toronto; Division of Neurosurgery (Z.K., N.H.), Department of Surgery, University of British Columbia, Royal Columbian Hospital, New Westminster; Department of Diagnostic Radiology (U.-E.E.), Dalhousie University, QEII Health Sciences Centre, Halifax; Division of Neurology (R.F.), Department of Medicine, University of Ottawa, The Ottawa Hospital; and Division of Neurology (G.B.W.), Department of Medicine, University of British Columbia, Royal Columbian Hospital, New Westminster, Canada
| | - Robert Fahed
- From the Division of Neurosurgery (A.P.W.), Department of Surgery, University of Ottawa, The Ottawa Hospital; Faculty of Kinesiology (S.T.H.), University of Toronto; Division of Neurosurgery (Z.K., N.H.), Department of Surgery, University of British Columbia, Royal Columbian Hospital, New Westminster; Department of Diagnostic Radiology (U.-E.E.), Dalhousie University, QEII Health Sciences Centre, Halifax; Division of Neurology (R.F.), Department of Medicine, University of Ottawa, The Ottawa Hospital; and Division of Neurology (G.B.W.), Department of Medicine, University of British Columbia, Royal Columbian Hospital, New Westminster, Canada
| | - Gregory B Walker
- From the Division of Neurosurgery (A.P.W.), Department of Surgery, University of Ottawa, The Ottawa Hospital; Faculty of Kinesiology (S.T.H.), University of Toronto; Division of Neurosurgery (Z.K., N.H.), Department of Surgery, University of British Columbia, Royal Columbian Hospital, New Westminster; Department of Diagnostic Radiology (U.-E.E.), Dalhousie University, QEII Health Sciences Centre, Halifax; Division of Neurology (R.F.), Department of Medicine, University of Ottawa, The Ottawa Hospital; and Division of Neurology (G.B.W.), Department of Medicine, University of British Columbia, Royal Columbian Hospital, New Westminster, Canada
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Adra A, Brigode W, Bokhari F. An Evaluation of Diagnostic Tests for Aerodigestive Injuries in Penetrating Neck Trauma. Am Surg 2023; 89:6353-6355. [PMID: 37157826 DOI: 10.1177/00031348231175100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
Assessment of aerodigestive injuries in penetrating neck trauma (PNT) is currently left up to the discretion of physicians which can result in a lot of confusion and unnecessary testing. This study was performed at a level 1 trauma center to assess the role of computed tomography arteriogram (CTA) in evaluating for aerodigestive injury in PNT. A total of 242 patients met criteria, with ages ranging from 7 to 86 years. Computed tomography arteriogram, EGD, esophagography, and bronchoscopy were classified into positive, negative, and indeterminate results. Computed tomography arteriogram was then further analyzed for violation of the carotid sheath, investing, pretracheal, and deep cervical fascias. Results showed a high sensitivity and NPV (100%) of CTA in assessing aerodigestive injury. Computed tomography arteriogram is a reliable first-line screening tool for aerodigestive injury. EGD appears more useful than esophagography at identifying esophageal injuries. Esophagography and bronchoscopy should be reserved to aid in injury management decision-making rather than as screening studies.
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Affiliation(s)
- Amal Adra
- Rush Medical College, Chicago, IL, USA
| | - William Brigode
- Department of Trauma and Burn, John H Stroger Jr Hospital of Cook County, Chicago, IL, USA
| | - Faran Bokhari
- Department of Trauma and Burn, John H Stroger Jr Hospital of Cook County, Chicago, IL, USA
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Swendiman RA, Scaife JH, Barnes KL, Bell TM, Roach CM, Iyer RR, Brockmeyer DL, Russell KW. Hanging and Strangulation Injuries: An Institutional Review From a Level 1 Pediatric Trauma Center. J Pediatr Surg 2023; 58:1995-1999. [PMID: 37002058 DOI: 10.1016/j.jpedsurg.2023.02.056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Revised: 02/11/2023] [Accepted: 02/21/2023] [Indexed: 05/25/2023]
Abstract
BACKGROUND We sought to define the incidence and outcomes of pediatric hanging and strangulation injuries to inform best practices for trauma triage and management. METHODS A retrospective review was conducted that included all patients who presented after hanging or strangulation to a Level I Pediatric Trauma Center from 2011 through 2021. Patient demographics, injury characteristics, and clinical outcomes were collected. All imaging modalities of the head and neck were reviewed to determine if a bony fracture or vascular injury was present. RESULTS Over the 11-year study period, 128 patients met inclusion criteria. The median age of the cohort was 13 years [IQR: 8.5-15], most patients were male (60.9%), and the median GCS was 11 [3, 15]. There were 96 cases (75%) that were intentional injuries. 76 patients (59.4%) received imaging in the form of plain radiographs, CT, or MRI of the neck and cervical spine. No fractures were identified and there were 0 clinically significant cervical spine injuries. CT angiograms of the neck identified no cerebral vascular injuries. Mortality was high (32%), and 25% of patients with nonaccidental injuries had a documented prior suicide attempt. CONCLUSION We identified no cervical spine fractures and no blunt cerebral vascular injuries after a hanging or strangulation in over 10 years at a Level 1 Pediatric Trauma Center. Use of CT and CT angiography of the neck and cervical spine should be minimized in this patient population without high clinical index of suspicion and/or significant mechanism. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Robert A Swendiman
- Division of Pediatric Surgery, University of Utah, Salt Lake City, UT, USA.
| | - Jack H Scaife
- University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Kacey L Barnes
- Division of Pediatric Surgery, University of Utah, Salt Lake City, UT, USA
| | - Teresa M Bell
- Division of Pediatric Surgery, University of Utah, Salt Lake City, UT, USA
| | | | - Rajiv R Iyer
- Department of Neurosurgery, University of Utah, Salt Lake City, UT, USA
| | | | - Katie W Russell
- Division of Pediatric Surgery, University of Utah, Salt Lake City, UT, USA
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Laher N, Monzon-Torres B, Mauser M. Surgical exploration for penetrating neck trauma - an audit of results in 145 patients. S AFR J SURG 2023; 61:17-20. [PMID: 37791709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/05/2023]
Abstract
BACKGROUND Selective non-operative management (SNOM) is the current gold standard for the treatment of patients with penetrating neck trauma. The policy revolves around the liberal use of computed tomography angiography (CTA) in those patients who are haemodynamically stable, irrespective of the anatomical zone of injury, aiming at reducing the incidence of negative and non-therapeutic interventions and their potential complications. METHODS A retrospective audit of results of patients who underwent immediate surgical exploration at the Chris Hani Baragwanath Academic Hospital in Soweto between January 2010 and December 2015 was performed. RESULTS One-hundred and forty-five (145) patients, with a median age of 28 years (range 18-67 years), predominantly males (93.8%), underwent immediate exploration. Most injuries were caused by stab wounds (92.4%) and affected zone 2 (54.1%) on the left side of the neck (69.6%). The most common presentations were active haemorrhage (29.4%), shock (24.1%) and expanding haematoma (15.1%). A major vascular injury was found in 40%, and aero-digestive organ injury in 19.3%. The rate of negative-non-therapeutic exploration in this cohort was 4.1%. Complications were recorded in 7.6%, and the overall mortality was 9.6% secondary to early uncontrolled haemorrhage, sepsis and occlusive strokes. CONCLUSIONS The utilisation of SNOM with strict criteria for selection of patients who require immediate surgical exploration versus investigations with CTA results in a low rate of non-therapeutic interventions.
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Affiliation(s)
- N Laher
- Trauma Unit, School of Clinical Medicine, Charlotte Maxeke Johannesburg Academic Hospital, University of the Witwatersrand, South Africa
| | - B Monzon-Torres
- Trauma Unit, Steve Biko Academic Hospital, Faculty of Health Sciences, University of Pretoria, South Africa
| | - M Mauser
- Trauma Directorate, Department of Surgery, Chris Hani Baragwanath Academic Hospital, University of the Witwatersrand, South Africa
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Wu EY, Curran PL, Zukowski M, King TS, Martin KL, Grant CN. Cervical Collar Clearance in Obtunded Children Presenting Without a Known Traumatic Mechanism: Is Imaging Necessary? J Pediatr Surg 2023; 58:1494-1499. [PMID: 37029027 DOI: 10.1016/j.jpedsurg.2023.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Revised: 03/08/2023] [Accepted: 03/09/2023] [Indexed: 04/09/2023]
Abstract
BACKGROUND Obtunded pediatric patients are often placed in cervical collars (c-collars) to protect their cervical spine (c-spine) while injury is being ruled out, even without a known traumatic injury. The goal of this study was to determine the necessity of c-collars in this population by determining the rate of c-spine injury among patients with suspected non-traumatic mechanisms of loss of consciousness. METHODS A single institution, ten-year retrospective chart review was conducted including all obtunded patients admitted to the Pediatric Intensive Care Unit without a known traumatic event. Patients were categorized into five groups based on etiology of obtundation: respiratory, cardiac, medical/metabolic, neurologic, and other. Comparisons were made between those placed in a c-collar and a control group who were not, using Wilcoxon rank sum test for continuous measures, and Chi-square or Fisher's exact test for categorical measures. RESULTS 464 patients were included, of which 39 (8.41%) were placed in a c-collar. There was a significant difference in whether a patient was placed in a c-collar based on diagnosis category (p < 0.001). Those placed in a-c-collar were more likely to undergo imaging studies than the control group (p < 0.001). The overall incidence of c-spine injury in this patient population in our study was zero. CONCLUSION Cervical collar placement and radiographic evaluation is not necessary in obtunded pediatric patients who present without a known traumatic mechanism as the overall risk of injury is low. Consideration for collar placement should be given in cases when trauma cannot be definitively ruled out at initial evaluation. LEVELS OF EVIDENCE III.
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Affiliation(s)
- Emma Y Wu
- Penn State College of Medicine, 700 HMC Cres Rd, Hershey, PA 17033, USA
| | - Pierce L Curran
- Penn State College of Medicine, 700 HMC Cres Rd, Hershey, PA 17033, USA
| | - Monica Zukowski
- Penn State College of Medicine, 700 HMC Cres Rd, Hershey, PA 17033, USA
| | - Tonya S King
- Department of Public Health Sciences, Penn State Hershey Medical Center, 500 University Dr, Hershey, PA 17033, USA
| | - Kathryn L Martin
- Penn State College of Medicine, 700 HMC Cres Rd, Hershey, PA 17033, USA; Department of Surgery, Division of Pediatric Surgery, Penn State Hershey Medical Center, 500 University Dr, Hershey, PA 17033, USA
| | - Christa N Grant
- Penn State College of Medicine, 700 HMC Cres Rd, Hershey, PA 17033, USA; Department of Surgery, Division of Pediatric Surgery, Penn State Hershey Medical Center, 500 University Dr, Hershey, PA 17033, USA.
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Alayaaf AS, Kim YS. Thyroid gland injury after blunt neck trauma: a case report. ULUS TRAVMA ACIL CER 2023; 29:834-836. [PMID: 37409919 PMCID: PMC10405037 DOI: 10.14744/tjtes.2023.77567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2022] [Accepted: 03/02/2023] [Indexed: 07/07/2023]
Abstract
Soft-tissue injuries are relatively common after blunt neck trauma. Due to neck content, several vital structures can be compromised. Isolated trauma to the thyroid is highly uncommon, and few cases are reported in the literature. A 61-year-old otherwise healthy woman sustained blunt trauma to the left frontal half of the neck caused by seatbelt injury in a motor vehicle accident. She presented with a painful anterior neck swelling associated with dyspnea. Computed tomography showed the left thyroid lobe lacerations with features suggestive of thyroid gland active bleeding. She underwent surgical exploration with left thyroidectomy and recovered un-eventfully. Isolated thyroid gland injury is infrequent and is present in about 1-2% of the cases, and in most reported cases, there is an underlining pathology within the gland. Patients can be present with neck swelling, pain, respiratory distress, and dysphagia. Patients who sustained blunt neck trauma should be assessed and stabilized according to the ATLS® principles. Injury to vital structures should be ruled out first. Although these cases are rare, physicians should consider the possibility of thyroid injury after blunt neck trauma or neck swelling is noted.
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Affiliation(s)
| | - Yoo Seok Kim
- Department of Surgery, Chosun University College of Medicine, Chosun University Hospital, Gwangju-Korea
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Rodriguez A, Nunez L, Riascos R. Vascular Injuries in Head and Neck Trauma. Radiol Clin North Am 2023; 61:467-477. [PMID: 36931763 DOI: 10.1016/j.rcl.2023.01.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/21/2023]
Abstract
Blunt and penetrating vascular injuries of the head and neck can represent life-threatening emergencies that require accurate detection to prevent devastating and long-lasting consequences. Implementing appropriate screening criteria to indicate imaging studies is crucial as there is a variable latent time before the onset of clinical manifestations. Computed tomography angiography, MR imaging, and digital subtraction angiography represent the imaging modalities of choice to evaluate vascular injuries. The aim of this review is to provide a description of the different types of vascular injuries, describe the importance of each imaging modality, and recognize the imaging appearance of traumatic vessel injury.
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Affiliation(s)
- Andres Rodriguez
- Department of Diagnostic and Interventional Imaging, Neuroradiology Section, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Luis Nunez
- Department of Diagnostic and Interventional Imaging, Neuroradiology Section, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Roy Riascos
- Department of Diagnostic and Interventional Imaging, Neuroradiology Section, The University of Texas Health Science Center at Houston, Houston, TX, USA.
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Pickering C, Muzaffar J, Reid C, Zakaria B, Coulson C, Sharma N, Breeze J. Management and outcomes of military penetrating neck injuries: An eleven-year retrospective case note review. Injury 2023; 54:119-123. [PMID: 36400629 DOI: 10.1016/j.injury.2022.11.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Revised: 10/26/2022] [Accepted: 11/08/2022] [Indexed: 11/13/2022]
Abstract
INTRODUCTION Penetrating Neck Injuries (PNIs) affected 3.2% of trauma patients attending US and UK deployed medical treatment facilities (MTFs) during the Iraq and Afghanistan conflicts. Injured military personnel requiring aeromedical evacuation for such injuries were managed at the Royal Centre for Defence Medicine (RCDM), Birmingham, UK. The aim of this paper was to review the management of PNI in both deployed MTFs and when evacuated back to the UK. PATIENTS AND METHODS A retrospective case note review was performed of all military patients who sustained PNI whilst on deployment overseas, and who were subsequently evacuated to RCDM between March 2003 and December 2014. RESULTS Forty casualties who sustained PNI were identified, of which 28/40 (70%) sustained injury from explosive fragmentation, and 11/40 (28%) from gunshot wounds. Hard signs of PNI were present in 3/40 (7.5%) patients, soft signs in 14/40 (35%), no signs in 12/40 (30%), and unknown signs in 11/40 (28%) patients. Computed tomography angiography (CTA) was used in 39/40 (98%) patients, and was effective at ruling out significant injury, with 100% (29/29) of casualties with a negative CTA not developing vascular or aerodigestive injury. There were 9/29 (31%) patients who had surgical neck exploration despite both a negative CTA and absence of hard signs of PNI. There were 12/40 (30%) patients who required operative intervention at RCDM. CONCLUSION UK military surgeons in Role 3 MTFs had a low threshold for surgical exploration, even in the absence of CT findings or hard signs. This was likely due to the high-energy mechanisms responsible for military PNI, in addition to the limited availability of equipment and clinical expertise in visualising the larynx.
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Affiliation(s)
- Christopher Pickering
- Queen Elizabeth Hospital Birmingham, Mindelsohn Way, University Hospitals Birmingham NHS Foundation Trust, Birmingham, B15 2GW, UK; Royal Centre for Defence Medicine, Level 2 Queen Elizabeth Hospital Birmingham, Mindelsohn Way, Birmingham, B15 2WB, UK.
| | - Jameel Muzaffar
- Queen Elizabeth Hospital Birmingham, Mindelsohn Way, University Hospitals Birmingham NHS Foundation Trust, Birmingham, B15 2GW, UK; Royal Centre for Defence Medicine, Level 2 Queen Elizabeth Hospital Birmingham, Mindelsohn Way, Birmingham, B15 2WB, UK; University of Cambridge School of Clinical Medicine, Box 111, Cambridge Biomedical Campus, Cambridge, CB2 0SP, UK.
| | - Conor Reid
- Queen Elizabeth Hospital Birmingham, Mindelsohn Way, University Hospitals Birmingham NHS Foundation Trust, Birmingham, B15 2GW, UK; Royal Centre for Defence Medicine, Level 2 Queen Elizabeth Hospital Birmingham, Mindelsohn Way, Birmingham, B15 2WB, UK.
| | - Benjamin Zakaria
- Queen Elizabeth Hospital Birmingham, Mindelsohn Way, University Hospitals Birmingham NHS Foundation Trust, Birmingham, B15 2GW, UK; University of Birmingham Medical School, College of Medical and Dental Sciences, Birmingham, B15 2TT, UK.
| | - Christopher Coulson
- Queen Elizabeth Hospital Birmingham, Mindelsohn Way, University Hospitals Birmingham NHS Foundation Trust, Birmingham, B15 2GW, UK; University of Birmingham Medical School, College of Medical and Dental Sciences, Birmingham, B15 2TT, UK.
| | - Neil Sharma
- Queen Elizabeth Hospital Birmingham, Mindelsohn Way, University Hospitals Birmingham NHS Foundation Trust, Birmingham, B15 2GW, UK; University of Birmingham Medical School, College of Medical and Dental Sciences, Birmingham, B15 2TT, UK.
| | - John Breeze
- Queen Elizabeth Hospital Birmingham, Mindelsohn Way, University Hospitals Birmingham NHS Foundation Trust, Birmingham, B15 2GW, UK; Royal Centre for Defence Medicine, Level 2 Queen Elizabeth Hospital Birmingham, Mindelsohn Way, Birmingham, B15 2WB, UK.
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Cao J, Xie N, Qian P, Hu M, Tu J. Feasibility analysis of high pitch cervical spine CT in uncooperative patients with acute cervical spine trauma: An initial experience. Medicine (Baltimore) 2022; 101:e30785. [PMID: 36181071 PMCID: PMC9524935 DOI: 10.1097/md.0000000000030785] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Cervical computed tomography (CT) often suffers from examination failure in uncooperative patients with acute cervical spinal trauma. Therefore, this study aimed to evaluate the feasibility of using high-pitch cervical CT (HP-CT) in such populations. A total of 95 patients with acute neck/head-neck trauma who underwent HP-CT (n = 29) or standard cervical CT (SD-CT, n = 66) from October 2020 to June 2021 were included in this study. Differences in patient characteristics between the HP-CT group and the SD-CT group were firstly compared. Then, the objective image quality based on the mean score of the signal-to-noise ratio (SNR)/contrast noise ratio (CNR) was evaluated, while double-blind five-point scoring was adopted for the subjective evaluation. Finally, radiation doses in HP-CT and SD-CT were compared. Furthermore, the Student t test and/or Mann-Whitney U test were performed to analyze differences in patient characteristics, image quality, and radiation dose between the two regimes. A total of 17 cases of cervical spine fractures were found in 95 patients, including 6 cases in the HP-CT group and 11 cases in the SD-CT group. The average age of patients who received HP-CT was higher than that of those who received SD-CT, and the scan time using HP-CT was shorter than that SD-CT. The differences were statistically significant (both, P < .05). In addition, there was no significant difference between HP-CT and SD-CT in terms of sex, body mass index, field of view (FOV), and scan length (all P > .05). The SNR/CNR at the middle and upper neck was not significantly different between HP-CT and SD-CT (all P > .05). However, the SNR/CNR at the lower neck in HP-CT was lower than that in SD-CT (all P < .05). There was no significant difference in the subjective scores between HP-CT and SD-CT images in both the soft tissue and bone window (P = .129 and 0.649, respectively). The radiation dose in HP-CT was lower than that in SD-CT (all P < .05). With a scan time reduction of 73%, radiation dose reduction of 10%, and similar image quality, high-pitch cervical CT was of feasibility to evaluate cervical spine injury in uncooperative patients with acute cervical spine trauma.
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Affiliation(s)
- Juntao Cao
- Department of Radiology, Kunshan Hospital of Traditional Chinese Medicine, Jiangsu Province, China
| | - Na Xie
- Department of Medical Imaging, Kunshan Maternal and Child Health Hospital, China
| | - Pingkang Qian
- Trauma Center, Kunshan Hospital of Traditional Chinese Medicine, China
| | - Ming Hu
- Department of Radiology, Kunshan Hospital of Traditional Chinese Medicine, Jiangsu Province, China
| | - Jianchun Tu
- Department of Radiology, Kunshan Hospital of Traditional Chinese Medicine, Jiangsu Province, China
- *Correspondence: Jianchun TU, Department of Radiology, Kunshan Hospital of Traditional Chinese Medicine. No. 189, Chaoyangxi Road, Kunshan City 215300, Jiangsu Province, China (e-mail: )
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Ben Saida F, Mleyhi S, Daoud Z, Ziadi J, Denguir R. Successful management of an acute carotid dissection by direct neck injury. J Med Vasc 2022; 47:150-152. [PMID: 36055685 DOI: 10.1016/j.jdmv.2022.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Accepted: 06/27/2022] [Indexed: 06/15/2023]
Affiliation(s)
| | - S Mleyhi
- Larabta Hospital, La Rabta, Tunisia
| | - Z Daoud
- Larabta Hospital, La Rabta, Tunisia
| | - J Ziadi
- Larabta Hospital, La Rabta, Tunisia
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13
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Karakoyun DO, Yılmaz A, Uzlu O, Daglioglu E, Işık HS. Vertebral arteriovenous fistula due to blunt neck trauma: A case report. ULUS TRAVMA ACIL CER 2022; 28:871-875. [PMID: 35652878 PMCID: PMC10443019 DOI: 10.14744/tjtes.2020.72506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Accepted: 09/17/2020] [Indexed: 11/20/2022]
Abstract
The arteriovenous fistulas (AVFs) of the vertebral artery are usually caused by iatrogenic and penetrating traumas. Vertebral AVF is rarely seen after blunt cervical trauma. A 65-year-old male patient applied to the emergency clinic due to falling from a height of about 3 m. In his neurological examination, he had weakness in the left upper limb and tinnitus in the left ear. The cervical computed tomog-raphy examination showed a Hangman's fracture, a C3 vertebra corpus compression fracture, and a C1 anterior arch fracture. There was a separation on the C1-2 transverse foramen due to the fracture, and there was a fracture in the left C3-4 transverse foramen. In cervical magnetic resonance imaging (MRI), the presence of a contusion in the spinal cord at the C2 corpus level was observed. Through an MRI angiography examination of the vertebral artery, it was determined that the left vertebral artery had developed an AVF at the V2-3 segment level. Stabilization surgery was performed with a posterior approach for unstable vertebrae. Then, vertebral AVF was then closed endovascularly using a stent coil. Improvement in neurological deficit was seen after surgery and endovascular treatment. There were no complications related to the procedure. Transverse foramen should be carefully evaluated, especially in the upper cervical trauma. Vertebral artery imaging should be performed before instability surgery in the presence of a separation in the fracture line to determine whether the damage to the vertebral artery is iatrogenic.
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Affiliation(s)
| | - Ali Yılmaz
- Department of Neurosurgery, Ordu University Faculty of Medicine, Ordu-Turkey
| | - Oğuzhan Uzlu
- Department of Neurosurgery, Ordu University Faculty of Medicine, Ordu-Turkey
| | - Ergun Daglioglu
- Department of Neurosurgery, Ankara City Hospital, Ankara-Turkey
| | - Hasan Serdar Işık
- Department of Neurosurgery, Ordu University Faculty of Medicine, Ordu-Turkey
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Das S, Lakshmanan J, Alexander A, Hansdah R. Undiagnosed pharyngeal perforation following a penetrating neck trauma in a 5-year-old child: a proposed treatment algorithm. BMJ Case Rep 2021; 14:e244098. [PMID: 34493559 PMCID: PMC8424826 DOI: 10.1136/bcr-2021-244098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/29/2021] [Indexed: 11/04/2022] Open
Abstract
External penetrating wounds of the neck leading to pharyngeal perforations are relatively uncommon. The small area of the neck contains the vital vascular, aerodigestive and nervous structures, which are difficult to access surgically. Pharyngeal perforations are challenging to treat, especially in children, as primary wound inspection may be difficult, leading to life-threatening complications like retropharyngeal abscesses, mediastinitis or airway compromise. The following is a case report of a 5-year-old girl who had a road traffic accident causing a neck laceration with a pharyngeal tear, which was only identified during emergency neck exploration in the operating room. A review of known literature and a proposed algorithm for managing penetrating neck injuries with pharyngeal injury is described.
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Affiliation(s)
- Sauradeep Das
- ENT, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, Puducherry, India
| | - Jijitha Lakshmanan
- ENT, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, Puducherry, India
| | - Arun Alexander
- ENT, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, Puducherry, India
| | - Rashmi Hansdah
- ENT, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, Puducherry, India
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15
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Kline-Fath BM, Seman JM, Zhang B, Care MM. Pediatric hanging and strangulation: is vascular injury a true risk? Pediatr Radiol 2021; 51:1889-1894. [PMID: 33783577 DOI: 10.1007/s00247-021-05056-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Revised: 02/09/2021] [Accepted: 03/16/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Acute screening of pediatric strangulation and hanging injuries has evolved at many institutions to include cervical arterial vascular imaging. As current standards in pediatric imaging support less radiation exposure and increased imaging appropriateness, it is questionable whether vascular arterial injury is a true risk in this population. OBJECTIVE To determine the role of cervical vascular arterial imaging in the evaluation of pediatric hanging and strangulation injuries. MATERIALS AND METHODS This is a retrospective study of patients who present at a Level 1 pediatric trauma center with a history of hanging and strangulation injuries. All relevant studies, including computed tomography (CT) angiography of the neck, contrast-enhanced neck CT, cervical magnetic resonance (MR) angiography, magnetic resonance imaging (MRI) and/or CT of the brain and cervical spine and associated clinical records, were reviewed. RESULTS Sixty-six patients were identified, 60 with vascular arterial imaging studies. No vascular injury was identified. Soft-tissue injury was noted in 20/66 (30%) patients and craniocervical injury was suspected in 2/66 (3%), but no cervical spine fracture was identified. Only 49 patients had brain imaging, with 7/49 (14%) demonstrating changes consistent with cerebral edema, which correlated negatively with survival (P<0.01). CONCLUSION Vascular arterial imaging, particularly with CT angiography, performed in the pediatric population after hanging and strangulation injury resulted in no positive studies for cervical arterial injury. This study supports the need to reevaluate routine screening CT angiography in this study population.
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Affiliation(s)
- Beth M Kline-Fath
- Department of Radiology and Medical Imaging, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave., Cincinnati, OH, 45229, USA.
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA.
| | - Jessica M Seman
- Department of Radiology and Medical Imaging, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave., Cincinnati, OH, 45229, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Bin Zhang
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
- Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Marguerite M Care
- Department of Radiology and Medical Imaging, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave., Cincinnati, OH, 45229, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
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16
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Mikkelsen R, Mølgaard ME, Høy K. [Cervical spine fracture in a nine-year-old girl in spite of a normal CT scan]. Ugeskr Laeger 2021; 183:V09200635. [PMID: 34477084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
In this case report, a nine-year-old girl was seen in the emergency department due to neck pain following a trampoline accident ten days ago. She had experienced paraesthesia in her left arm immediately after the accident, but these symptoms disappeared during the first day. A CT scan of the cervical spine was found to be normal. A supplementary MRI was done, showing compression fractures of four vertebrae C7-Th3 besides a torn interspinous ligament between C7 and Th1. The patient was kept in a neck collar for eight weeks. At the end of treatment, she was without any complaints.
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17
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Scott J, Grewal T, Brewster S, Khan A. Optimizing imaging in the pediatric trauma patient, part 1: head and neck trauma. Pediatr Emerg Med Pract 2021; 18:1-39. [PMID: 34423962] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Trauma is the leading cause of death in the pediatric population and is among the most common reasons for ED visits by children. Imaging is an important tool for the diagnosis and management of pediatric trauma, but there are risks associated with exposure to ionizing radiation. In pediatric head and neck injuries, clinical findings and clinical decision tools can help inform selection of the most appropriate imaging modalities for the trauma patient, while also reducing unnecessary radiation exposure. This supplement reviews evidence-based recommendations for imaging decisions and interpretations in skull fractures, traumatic brain injuries, abusive head trauma, cervical spine injuries, and facial bone fractures. Examples demonstrating imaging modalities and specific findings for the types of injuries are also provided.
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Affiliation(s)
- Jinel Scott
- Associate Professor, Department of Radiology, State University of New York Downstate Health Sciences University; Director of Emergency Radiology, Quality Improvement and Patient Safety, Department of Radiology, NYC Health+Hospitals/Kings County, Brooklyn, NY
| | - Tarundeep Grewal
- Department of Radiology, State University of New York Downstate Health Sciences University, Brooklyn, NY
| | - Selwena Brewster
- Clinical Assistant Professor of Emergency Medicine, Director of Emergency Department Quality Improvement, Director of Emergency Department Observation Unit, NYC Health+Hospitals/Kings County, Brooklyn, NY
| | - Ambreen Khan
- Fellowship Director, Pediatric Emergency Medicine; Assistant Professor, Department of Emergency Medicine, State University of New York Downstate Health Sciences University/NYC Health+Hospitals/Kings County, Brooklyn, NY
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Eddy FK, Ngano SO, Jervé FA, Serge A. Optimization of the scan length of head traumas on the pediatric and adult CT scan and proposition of a new acquisition limit. Sci Rep 2021; 11:10958. [PMID: 34040095 PMCID: PMC8155083 DOI: 10.1038/s41598-021-90529-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2020] [Accepted: 05/10/2021] [Indexed: 11/15/2022] Open
Abstract
To propose a new method of reducing the scan length of head trauma while keeping the diagnostic efficiency of the examination in order to develop DRL in an African context. This is a retrospective single-center study including 145 patients who had cranial examinations on a 64-barettes scanner. All head trauma cases were selected. The interpretations of these CT scanners by the three radiologists of the service were noted to determine the acquisition limit. All patient acquisition lengths have been recorded. The acquisition limit for head trauma ended in clinical routine at cervical spine 4 (C4). The average scan length was 23.03 cm. Out of the CT scan results for 145 patients, only 2 (1.37%) had a C3 level cervical spine fracture and 2 (1.37%) at C4. By respecting the principles of radiation protection, this result has shown us that it is possible to limit the acquisition length of the CT scanners indicated for head trauma. The limit of the optimized scan length that we proposed is at cervical spine 2 (98.62%). Now, all head trauma are limited on cervical vertebra 2 in our hospital. The use of this new method is beneficial when the clinical indication of the examination and the type of trauma (multi-trauma) are taken into account. Based on the principles of radiation protection and the clinical indication for the examination, reducing the scan length from C4 to C2 is an effective way to reduce the dose absorbed by the patient.
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Affiliation(s)
- Fotso Kamdem Eddy
- Unité de Recherche de la Matière Condensée, d'Electronique et de Traitement du Signal, Department of Physics, Faculty of Science, University of Dschang, Dschang, Cameroon.
| | - Samba Odette Ngano
- Unité de Recherche de la Matière Condensée, d'Electronique et de Traitement du Signal, Department of Physics, Faculty of Science, University of Dschang, Dschang, Cameroon
- Department of Radiography, Yaoundé General Hospital, Yaoundé, Cameroon
| | - Fotue Alain Jervé
- Unité de Recherche de la Matière Condensée, d'Electronique et de Traitement du Signal, Department of Physics, Faculty of Science, University of Dschang, Dschang, Cameroon
| | - Abogo Serge
- Department of Radiology, National Social Insurance Fund Hospital, Yaoundé, Cameroon
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Kim SK, Chang DG, Park JB, Seo HY, Kim YH. Traumatic atlanto-axial rotatory subluxation and dens fracture with subaxial SCIWORA of Brown-Sequard syndrome: A case report. Medicine (Baltimore) 2021; 100:e25588. [PMID: 33879718 PMCID: PMC8078422 DOI: 10.1097/md.0000000000025588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Accepted: 03/31/2021] [Indexed: 01/04/2023] Open
Abstract
RATIONALE A case of traumatic atlanto-axial rotatory subluxation (AARS), dens fracture, rupture of transverse atlantal ligament (TAL), and subaxial spinal cord injury without radiographic abnormality (SCIWORA) of Brown-Sequard syndrome has never been reported in a child. PATIENT CONCERNS A 7-year-old boy presented to hospital with torticollis, neck pain, and limited neck rotation after a seat-belt injury sustained during a car accident. Neurologic examination revealed right-side motor weakness and left-side sensory abnormality, known as Brown-Sequard syndrome. DIAGNOSIS Radiologic examinations revealed type II AARS (Fielding and Hawkins classification), increased atlanto-dental interval (ADI) of 4.5 mm due to a type 1B TAL rupture (Dickman classification), a displaced transverse dens fracture along with an ossiculum terminale, and an intramedullary hemorrhage on the right side of the spinal cord at C3-4. INTERVENTIONS The patient immediately received methylprednisolone, and his motor weakness and sensory abnormality gradually improved. At the same time, the patient underwent initial halter traction for 2 weeks, but he failed to achieve successful reduction and required manual reduction under general anesthesia. OUTCOMES At the 7-month follow-up visit, radiologic examinations showed a corrected type II AARS that was well maintained and normalization of the ADI to 2 mm. The reduced transverse dens fracture was well maintained but still not united. All clinical symptoms were significantly improved, except the remaining motor weakness of the right upper extremity. LESSONS To the best of our knowledge, this is the first report of traumatic AARS, dens fracture, TAL rupture, and subaxial SCIWORA of Brown-Sequard syndrome in a child. Appropriate diagnosis and careful treatment strategy are required for successful management of complex cervical injuries in a child.
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Affiliation(s)
- Sung-Kyu Kim
- Department of Orthopaedic Surgery, Chonnam National University Medical School and Hospital, Gwangju
| | - Dong-Gune Chang
- Department of Orthopaedic Surgery, Inje University Sanggye Paik Hospital, College of Medicine, Inje University
| | - Jong-Beom Park
- Department of Orthopaedic Surgery, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Hyoung-Yeon Seo
- Department of Orthopaedic Surgery, Chonnam National University Medical School and Hospital, Gwangju
| | - Yun Hwan Kim
- Department of Orthopaedic Surgery, College of Medicine, The Catholic University of Korea, Seoul, Korea
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20
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Runde D. Calculated decisions: Canadian c-spine rule. Emerg Med Pract 2020; 22:CD3-CD4. [PMID: 32805098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Accepted: 07/10/2020] [Indexed: 06/11/2023]
Abstract
The Canadian C-spine rule clinically clears cervical spine fracture without imaging.
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Affiliation(s)
- Daniel Runde
- Department of Emergency Medicine, University of Iowa, Iowa City, IA
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21
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Deininger-Czermak E, Heimer J, Tappero C, Thali MJ, Gascho D. The added value of postmortem magnetic resonance imaging in cases of hanging compared to postmortem computed tomography and autopsy. Forensic Sci Med Pathol 2020; 16:234-242. [PMID: 32221850 DOI: 10.1007/s12024-020-00233-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/13/2020] [Indexed: 11/26/2022]
Abstract
The purpose of this study was to evaluate the added value of postmortem magnetic resonance imaging (MRI) compared to postmortem computed tomography (CT) and autopsy in cases of fatal hanging. In addition, the study analyzed the strengths of each examination method regarding typical injuries in these cases. We investigated a cohort of 25 decedents who underwent CT, MRI and autopsy. Two radiologists assessed all MR images of the head and neck as well as the corresponding CT images. The results were compared to autopsy findings by retrospectively analyzing the autopsy reports. Postmortem MRI revealed intramuscular hemorrhages in a large number of cases, however, autopsy did not confirm all of the detected hemorrhages. CT and autopsy detected fractures in several cases, whereas MRI showed a fracture in just one single case. Other previously described vital signs and relevant findings, such as fracture-related gas bubbles, soft tissue emphysema or pneumomediastinum, were observed in only a few individual cases. MRI provided added diagnostic value in the detection of soft tissue injuries and lymph node swelling in fatal hangings. As an adjunct to autopsy, postmortem MRI may reveal additional hemorrhages, which might be missed at autopsy. Since standard MRI demonstrated low sensitivity for the detection of fractures, an additional imaging modality or autopsy is required to overcome this limitation.
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Affiliation(s)
- Eva Deininger-Czermak
- Department of Forensic Medicine and Imaging, Zurich Institute of Forensic Medicine, University of Zurich, Winterthurerstrasse, 190/52, CH-8057, Zurich, Switzerland.
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, Zurich, Switzerland.
| | - Jakob Heimer
- Department of Forensic Medicine and Imaging, Zurich Institute of Forensic Medicine, University of Zurich, Winterthurerstrasse, 190/52, CH-8057, Zurich, Switzerland
| | - Carlo Tappero
- Department of Forensic Medicine and Imaging, Zurich Institute of Forensic Medicine, University of Zurich, Winterthurerstrasse, 190/52, CH-8057, Zurich, Switzerland
- Department of Radiology, Hôpital Fribourgeois, Fribourg, Switzerland
| | - Michael J Thali
- Department of Forensic Medicine and Imaging, Zurich Institute of Forensic Medicine, University of Zurich, Winterthurerstrasse, 190/52, CH-8057, Zurich, Switzerland
| | - Dominic Gascho
- Department of Forensic Medicine and Imaging, Zurich Institute of Forensic Medicine, University of Zurich, Winterthurerstrasse, 190/52, CH-8057, Zurich, Switzerland
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22
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Tsuchiya R, Kamide T, Nakajima H, Torio T, Nemoto M, Suzuki K, Kikkawa Y, Kurita H. The distance of cervical vertebral dislocation could be a risk factor for blunt vertebral artery injury after traumatic cervical spine injury. Acta Neurochir (Wien) 2019; 161:2359-2363. [PMID: 31455995 DOI: 10.1007/s00701-019-04041-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2019] [Accepted: 08/11/2019] [Indexed: 02/06/2023]
Abstract
BACKGROUND Blunt vertebral artery injury (BVAI) is a well-known potentially fatal complication of cervical spine injury. The condition is reported to be associated with vertebral fractures and cervical hyperextension. However, appropriate patient screening methods remain to be elucidated. This study aimed to identify the risk factors associated with BVAI in patients with cervical spine injury. METHODS We conducted a retrospective, observational, single-centered study, including 137 patients with cervical spine injury transferred to our center from April 2007 to December 2016. Evaluation for BVAI was available in 62 patients based on magnetic resonance angiography or multi-detector computed tomography angiography. BVAI was classified using the Biffl grade. RESULTS Among the 62 patients evaluated, 13 (21%) were diagnosed with BVAI. All injuries were classified as Biffl grade 2 (50%) or 4 (50%). Univariate analysis of patients with and without BVAI showed that cervical dislocation (p = 0.041) and low average hemoglobin level (p = 0.032) were associated with BVAI. On multivariate logistic regression analysis, cervical dislocation (odds ratio 1.189; 95% confidence interval 1.011-1.399, p = 0.036) remained a significant predictor of BVAI. Based on receiver operating characteristic (ROC) analysis, a dislocation > 6.7 mm was selected as the optimal cutoff value for prediction of BVAI (sensitivity and specificity, 87.5% and 71.4%, respectively). CONCLUSIONS BVAI frequently occurred in combination with cervical spine dislocation, and the distance of the cervical dislocation was identified as a useful predictor of BVAI.
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Affiliation(s)
- Ryosuke Tsuchiya
- Department of Cerebrovascular Surgery, Saitama Medical University International Medical Center, Hidaka, Saitama, Japan
| | - Tomoya Kamide
- Department of Cerebrovascular Surgery, Saitama Medical University International Medical Center, Hidaka, Saitama, Japan.
| | - Hiroyuki Nakajima
- Department of Cerebrovascular Surgery, Saitama Medical University International Medical Center, Hidaka, Saitama, Japan
| | - Tetsuya Torio
- Department of Critical Care and Emergency, Saitama Medical University International Medical Center, Hidaka, Saitama, Japan
| | - Manabu Nemoto
- Department of Critical Care and Emergency, Saitama Medical University International Medical Center, Hidaka, Saitama, Japan
| | - Kaima Suzuki
- Department of Cerebrovascular Surgery, Saitama Medical University International Medical Center, Hidaka, Saitama, Japan
| | - Yuichiro Kikkawa
- Department of Cerebrovascular Surgery, Saitama Medical University International Medical Center, Hidaka, Saitama, Japan
| | - Hiroki Kurita
- Department of Cerebrovascular Surgery, Saitama Medical University International Medical Center, Hidaka, Saitama, Japan
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Sarkar R, Ozanne-Smith J, Bassed R. Methods in population study of orofacial injuries in Victorian family violence homicides. Forensic Sci Med Pathol 2019; 16:78-90. [PMID: 31642012 DOI: 10.1007/s12024-019-00183-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/03/2019] [Indexed: 11/27/2022]
Abstract
This study standardized the methods used in the determination of orofacial injuries in Victorian family violence homicides and informed potential control selection for an analytic study. Dental service contacts with family violence victims may be intervention avenues due to the presence of abusive injuries in the orofacial region. All Victorian family homicides from January 2000-September 2018 were identified by determining the kinship/relationship and grouped by age. A 20% random sample of adult cases, aged 18-64 years was selected. The median number of orofacial injuries in categories of injury mechanisms/age/gender and the nature of abusive orofacial injuries was reported for the sample. Of 357 closed cases of family homicide, 261 were adults aged 18-64 years. Offender information and injury mechanism data was available for all closed cases, enabling case selection. Of a random sample of 50 adults, 8 cases were excluded. After 2006, CT scans and photos were present in 20 (91%) and 19 (86.4%) of 22 cases, respectively. The nature and median number of orofacial injuries showed correlation to the reported injury mechanism. Strengths and limitations of the used methods were assessed. Not all cases were compatible for assessment of orofacial injuries, thus serving as an additional criterion for exclusion in our methodology. Further detailed study of the whole population of adults should be limited to the period 2006-2018 where the data is more complete. The mechanism of injury may influence control selection for analytic studies. We present preliminary evidence of the frequent occurrence of orofacial injuries in family violence homicides.
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Affiliation(s)
- Reena Sarkar
- Department of Forensic Medicine, Victorian Institute of Forensic Medicine, Monash University, 65 Kavanagh Street, Southbank, Melbourne, Victoria, 3006, Australia.
| | - Joan Ozanne-Smith
- Department of Forensic Medicine, Victorian Institute of Forensic Medicine, Monash University, 65 Kavanagh Street, Southbank, Melbourne, Victoria, 3006, Australia
| | - Richard Bassed
- Department of Forensic Medicine, Victorian Institute of Forensic Medicine, Monash University, 65 Kavanagh Street, Southbank, Melbourne, Victoria, 3006, Australia
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24
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Rana A, Heffernen L, Binchy J. Kicking off a Retropharyngeal Abscess. Ir Med J 2019; 112:900. [PMID: 31124349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Aim Retropharyngeal abscesses (RPA) are deep neck space infections that can pose an immediate life-threatening emergency, such as airway obstruction. [1] Methods We describe an atypical presentation of RPA in a three year old girl who attended with a history of post-traumatic Neck pain. Results MB presented to the Emergency department with neck pain and reduced range of motion following a kick to the neck by a sibling. Examination was unremarkable. Cervical spine x-ray showed psuedosubluxation of C2/C3 with a concern regarding facet joint injury. Ultimately, MRI revealed a RPA, which was incised and drained, and the patient treated with antibiotics. MB did not have any classic symptoms and signs of RPA. The history was misleading the treating physicians, and hence a delay in diagnosis. Conclusion This case highlights an unusual presentation of a retropharyngeal abscess and reminds us that trauma can often be a red herring in a patient’s presentation.
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Affiliation(s)
- A Rana
- Department of Emergency Medicine, University Hospital Galway, Ireland
| | - L Heffernen
- Department of Emergency Medicine, University Hospital Galway, Ireland
| | - J Binchy
- Department of Emergency Medicine, University Hospital Galway, Ireland
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25
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Boots RJ, Joyce C, Mullany DV, Anstey C, Blackwell N, Garrett PM, Gillis S, Alexander N. Near-Hanging as Presenting to Hospitals in Queensland: Recommendations for Practice. Anaesth Intensive Care 2019; 34:736-45. [PMID: 17183891 DOI: 10.1177/0310057x0603400610] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Near-hanging is an increasing presentation to hospitals in Australasia. We reviewed the clinical management and outcome of these patients as they presented to public hospitals in Queensland. A retrospective clinical record audit was made at five public hospitals between 1991 and 2000. Of 161 patients enrolled, 82% were male, 8% were indigenous and 10% had made a previous hanging attempt. Chronic medical illnesses were documented in 11% and previous psychiatric disorders in 42%. Of the 38 patients with a Glasgow Coma Scale score (GCS) of 3 on arrival at hospital, 32% returned to independent living and 63% died. Fifty-two patients received CPR, of whom 46% had an independent functional outcome. Independent predictors of mortality were a GCS on hospital arrival of 3 (AOR 150, CI 95% 12.4–1818, P<0.001), taking plain X-rays of the cervical spine (AOR 0.06, CI 95% 0.004–0.97, P=0.047) and contact with the ground (AOR 0.03, CI 95% 0.002–0.62, P=0.02). Only 66% had imaging of the cervical spine performed with other imaging performed infrequently. There were three laryngeal, two hyoid bone and three cervical spine injuries and one carotid dissection. The number of cervical spine X-rays required to find a significant cervical spine fracture was 54. Near-hanging presenting to hospital with a poor conscious state or even cardiac arrest can have a favourable clinical outcome. Radiological investigations are infrequently performed despite a low GCS precluding early accurate assessment. Given the general favourable outcome, an aggressive approach to searching for correctable injuries is recommended.
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Affiliation(s)
- R J Boots
- Department of Intensive Care, Royal Brisbane and Women's Hospital, Brisbane
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Li Z, Chen J, Qu X, Duan L, Huang C, Zhang D, Hou L. Management of a Steel Bar Injury Penetrating the Head and Neck: A Case Report and Review of the Literature. World Neurosurg 2018; 123:168-173. [PMID: 30447445 DOI: 10.1016/j.wneu.2018.11.029] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2018] [Revised: 11/02/2018] [Accepted: 11/04/2018] [Indexed: 11/19/2022]
Abstract
BACKGROUND Nonmissile penetrating injuries to the head and neck caused by a steel bar are rare, and a standard management strategy is lacking. CASE DESCRIPTION A 42-year-old woman sustained a steel bar injury with penetration of the head and neck. Computed tomography and three-dimensional reconstruction were performed for preoperative evaluation. Digital subtraction angiography was performed to confirm potential vascular injury. The steel bar was successfully removed through an open surgical procedure by a multidisciplinary team. CONCLUSIONS Relevant literature regarding nonmissile penetrating injuries involving a steel bar was reviewed to propose appropriate management strategies. Comprehensive imaging evaluation and prompt surgery by a multidisciplinary team contributed to the successful removal of the steel bar.
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Affiliation(s)
- Zhenxing Li
- Department of Neurosurgery, Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Jigang Chen
- Department of Neurosurgery, Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Xiaolin Qu
- Department of Neurosurgery, Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Liwei Duan
- Department of Emergency, Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Chenguang Huang
- Department of Neurosurgery, Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Danfeng Zhang
- Department of Neurosurgery, Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Lijun Hou
- Department of Neurosurgery, Changzheng Hospital, Second Military Medical University, Shanghai, China.
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Ala A, Shams Vahdati S, Ghaffarzad A, Mousavi H, Mirza-Aghazadeh-Attari M. National emergency X-radiography utilization study guidelines versus Canadian C-Spine guidelines on trauma patients, a prospective analytical study. PLoS One 2018; 13:e0206283. [PMID: 30388133 PMCID: PMC6214507 DOI: 10.1371/journal.pone.0206283] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2017] [Accepted: 10/10/2018] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION The most common cause of hospital emergency department visits is trauma resulting from a variety of underlying mechanisms. Unknown neck and spinal cord injuries and a lack of early diagnosis can have catastrophic consequences, such as paralysis of some or all limbs. The use of imaging techniques reduces the number of patients suffering from severe injuries. OBJECTIVE To assess and compare the effectiveness and ease of utilizing two different sets of guidelines, the National Emergency X-Radiography Utilization Study guidelines (NEXUS) and the Canadian C-Spine guidelines (CCR), on trauma patients. METHODS This study was approved by the Ethics Committee of Tabriz University of Medical Sciences. Of all the patients presenting to the hospital, 200 trauma patients were randomly included in the study. NEXUS and CCR were surveyed for each patient, and subsequent radiographies were also requested. The specificity and sensitivity of each of the methods was calculated, and the two methods were compared using Kendall's W test. RESULTS A total of 200 trauma patients who met the inclusion criteria were included in the study. A total of 69.5% of the patients were male, and 30.5% were female. According to NEXUS guidelines, 47.5% of the patients were required to undergo neck radiography. According to CCR guidelines, 57.5% of the patients were required to undergo neck radiography. The sensitivity was found to be 90% for neck radiography by both NEXUS and CCR guidelines, while specificities were found to be 54.73% and 44.2% for NEXUS and CCR guidelines, respectively. CONCLUSION This study showed that the two guidelines have the same sensitivity for evaluating which trauma patients need to undergo radiography. It seems that the NEXUS guidelines have the same effectiveness as CCR for determining which trauma patients need to undergo radiography. They also perform better than CCR guidelines in terms of ruling out which cases need no further radiologic investigation.
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Affiliation(s)
- Alireza Ala
- Emergency Department, Emergency Medicine Research Team, Tabriz University of Medical Science, Tabriz, Iran
| | - Samad Shams Vahdati
- Road Traffic Injury Research Center, Tabriz University of Medical Science, Tabriz, Iran
| | - Amir Ghaffarzad
- Emergency medicine research team, Tabriz University of Medical Science, Tabriz, Iran
| | - Haleh Mousavi
- Emergency Department, Emergency Medicine Research Team, Tabriz University of Medical Science, Tabriz, Iran
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Beckmann NM, Cai C, Spence SC, Prasarn ML, Clark West O. Is elevated body mass index protective against cervical spine injury in adults? Emerg Radiol 2018; 25:415-424. [PMID: 29603036 DOI: 10.1007/s10140-018-1602-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2018] [Accepted: 03/23/2018] [Indexed: 01/01/2023]
Abstract
PURPOSE Correlate body mass index (BMI) with incidence and type of cervical spine injury seen on CT in adult patients presenting with blunt trauma. MATERIALS AND METHODS Retrospective chart review of all adult blunt trauma patients who had a cervical spine CT performed at our level 1 trauma center during an approximately 3-year period. RESULTS A statistically significant (p = 0.01) difference in cervical spine injury incidence was present between different BMI groups. Cervical spine injury incidence was 7.7% for underweight (BMI ≤ 18) patients, 7.1% for normal weight (BMI 18-25) patients, 6.2% for overweight/obese (BMI 25-35) patients, and 4.7% for morbidly obese (BMI > 35) patients. Using BMI > 18-25 as a reference group, females with BMI > 25-35 had an adjusted odds ratio (aOR) of 0.56 (CI 0.41-0.75) and females with BMI > 35 had an aOR of 0.42 (CI 0.26-0.70). Males with a BMI ≤ 18 had an aOR of 2.20 (CI 1.12-4.32) and males with BMI > 35 had an aOR of 0.66 (CI 0.46-0.95). A particularly low incidence of cervical spine injury was observed in patients older than 65 in the obese group with a cervical spine injury rate of only 1.4% in this patient population. No statistical significant difference was seen in injury morphology across the BMI groups. CONCLUSION An inverse relationship exists between BMI and the overall incidence of cervical spine injury. This protective effect appears to be influenced by gender with elevated BMI having lower relative odds of cervical spine injury in women than in men. A particularly low rate of cervical spine injury was identified in obese patients over the age of 65. Routine imaging of all elderly, obese trauma patients with low energy mechanism of injury may not be warranted.
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Affiliation(s)
- Nicholas M Beckmann
- Department of Diagnostic and Interventional Imaging, McGovern Medical School, The University of Texas Health Science Center at Houston, 6431 Fannin Street, 2.130B, Houston, TX, 77030, USA.
| | - Chunyan Cai
- Department of Internal Medicine, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX, USA
- Biostatistics/Epidemiology/Research/Design Core, Center for Clinical and Translational Sciences, The University of Texas Health Science Center at Houston, 6410 Fannin, UTPB 1100.08, Houston, TX, 77030, USA
| | - Susanna C Spence
- Department of Diagnostic and Interventional Imaging, McGovern Medical School, The University of Texas Health Science Center at Houston, 6431 Fannin Street, 2.130B, Houston, TX, 77030, USA
| | - Mark L Prasarn
- Department of Orthopedic Surgery, McGovern Medical School, The University of Texas Health Science Center at Houston, 6431 Fannin Street, Houston, TX, 77030, USA
| | - O Clark West
- Department of Diagnostic and Interventional Imaging, McGovern Medical School, The University of Texas Health Science Center at Houston, 6431 Fannin Street, 2.130B, Houston, TX, 77030, USA
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Curtis BR, Curtis E. Perched facets diagnosed in a neurologically intact patient 5 weeks after a fall. Intern Emerg Med 2017; 12:1323-1325. [PMID: 28303439 DOI: 10.1007/s11739-017-1649-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2017] [Accepted: 03/08/2017] [Indexed: 11/26/2022]
Affiliation(s)
- Brian Reed Curtis
- Department of Radiology, Thomas Jefferson University Hospital, 132 South 10th Street, Philadelphia, PA, 19107, USA.
| | - Eric Curtis
- Virginia Commonwealth University School of Medicine, Richmond, VA, USA
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Qadeer M, Sharif S. Management of cervical trauma: A Brief review. J PAK MED ASSOC 2017; 67:760-766. [PMID: 28507367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Cervical injury is not uncommon in any trauma, especially in road traffic accident. A standard approach, towards, transport, workup, and management is required for best outcomes, and decrease morbidity. We tried to review the recent literature and briefly discuss the management protocols concluded that in our setting, emergency ambulance personnel and Emergency Room doctors should be trained in dealing with all kinds of cervical spine trauma, they should be aware of recent guidelines and should refrain from using steroids routinely. By following guidelines, large numbers of cervical spine injury patients can benefit.
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Affiliation(s)
- Mohsin Qadeer
- Department of Neurosurgery, Liaquat National Hospital, Karachi, Pakistan
| | - Salman Sharif
- Department of Neurosurgery, Liaquat National Hospital, Karachi, Pakistan
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Sato F, Odani M, Miyazaki Y, Yamazaki K, Östh J, Svensson M. Effects of whole spine alignment patterns on neck responses in rear end impact. Traffic Inj Prev 2017; 18:199-206. [PMID: 27576139 DOI: 10.1080/15389588.2016.1227072] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/01/2016] [Accepted: 08/17/2016] [Indexed: 06/06/2023]
Abstract
OBJECTIVE The aim of this study was to investigate the whole spine alignment in automotive seated postures for both genders and the effects of the spinal alignment patterns on cervical vertebral motion in rear impact using a human finite element (FE) model. METHODS Image data for 8 female and 7 male subjects in a seated posture acquired by an upright open magnetic resonance imaging (MRI) system were utilized. Spinal alignment was determined from the centers of the vertebrae and average spinal alignment patterns for both genders were estimated by multidimensional scaling (MDS). An occupant FE model of female average size (162 cm, 62 kg; the AF 50 size model) was developed by scaling THUMS AF 05. The average spinal alignment pattern for females was implemented in the model, and model validation was made with respect to female volunteer sled test data from rear end impacts. Thereafter, the average spinal alignment pattern for males and representative spinal alignments for all subjects were implemented in the validated female model, and additional FE simulations of the sled test were conducted to investigate effects of spinal alignment patterns on cervical vertebral motion. RESULTS The estimated average spinal alignment pattern was slight kyphotic, or almost straight cervical and less-kyphotic thoracic spine for the females and lordotic cervical and more pronounced kyphotic thoracic spine for the males. The AF 50 size model with the female average spinal alignment exhibited spine straightening from upper thoracic vertebra level and showed larger intervertebral angular displacements in the cervical spine than the one with the male average spinal alignment. CONCLUSIONS The cervical spine alignment is continuous with the thoracic spine, and a trend of the relationship between cervical spine and thoracic spinal alignment was shown in this study. Simulation results suggested that variations in thoracic spinal alignment had a potential impact on cervical spine motion as well as cervical spinal alignment in rear end impact condition.
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Affiliation(s)
- Fusako Sato
- a Japan Automobile Research Institute , Tsukuba , Ibaraki , Japan
- b Chalmers University of Technology , Göteborg , Sweden
| | - Mamiko Odani
- c Tokyo Institute of Technology , Meguro-ku , Tokyo , Japan
| | | | - Kunio Yamazaki
- a Japan Automobile Research Institute , Tsukuba , Ibaraki , Japan
| | - Jonas Östh
- b Chalmers University of Technology , Göteborg , Sweden
| | - Mats Svensson
- b Chalmers University of Technology , Göteborg , Sweden
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32
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Gittoes OMJ, Gittoes NJL. Breathlessness and neck swelling after a rugby game. BMJ 2017; 356:j311. [PMID: 28154129 DOI: 10.1136/bmj.j311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
| | - Neil J L Gittoes
- Centre for Endocrinology, Diabetes and Metabolism, Heritage Building, Queen Elizabeth Hospital, Edgbaston, Birmingham, UK
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33
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Lowe E, Patil S. Management of subacute airway emergency after blunt neck trauma. BMJ 2017; 356:j141. [PMID: 28126713 DOI: 10.1136/bmj.j141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Emily Lowe
- Southampton General Hospital, Southampton, UK
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34
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Kiraly B. Neck Crepitus in a Runner. Am Fam Physician 2017; 95:113-115. [PMID: 28084710] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
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Uriell ML, Allen JW, Lovasik BP, Benayoun MD, Spandorfer RM, Holder CA. Yield of computed tomography of the cervical spine in cases of simple assault. Injury 2017; 48:133-136. [PMID: 27842904 DOI: 10.1016/j.injury.2016.10.031] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2016] [Revised: 09/13/2016] [Accepted: 10/26/2016] [Indexed: 02/02/2023]
Abstract
BACKGROUND Computed tomography (CT) of the cervical spine (C-spine) is routinely ordered for low-impact, non-penetrating or "simple" assault at our institution and others. Common clinical decision tools for C-spine imaging in the setting of trauma include the National Emergency X-Radiography Utilization Study (NEXUS) and the Canadian Cervical Spine Rule for Radiography (CCR). While NEXUS and CCR have served to decrease the amount of unnecessary imaging of the C-spine, overutilization of CT is still of concern. METHODS A retrospective, cross-sectional study was performed of the electronic medical record (EMR) database at an urban, Level I Trauma Center over a 6-month period for patients receiving a C-spine CT. The primary outcome of interest was prevalence of cervical spine fracture. Secondary outcomes of interest included appropriateness of C-spine imaging after retrospective application of NEXUS and CCR. The hypothesis was that fracture rates within this patient population would be extremely low. RESULTS No C-spine fractures were identified in the 460 patients who met inclusion criteria. Approximately 29% of patients did not warrant imaging by CCR, and 25% by NEXUS. Of note, approximately 44% of patients were indeterminate for whether imaging was warranted by CCR, with the most common reason being lack of assessment for active neck rotation. CONCLUSIONS Cervical spine CT is overutilized in the setting of simple assault, despite established clinical decision rules. With no fractures identified regardless of other factors, the likelihood that a CT of the cervical spine will identify clinically significant findings in the setting of "simple" assault is extremely low, approaching zero. At minimum, adherence to CCR and NEXUS within this patient population would serve to reduce both imaging costs and population radiation dose exposure.
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Affiliation(s)
- Matthew L Uriell
- Emory University School of Medicine, Atlanta, GA, United States; Department of Radiology and Imaging Sciences, Emory University, Atlanta, GA, United States.
| | - Jason W Allen
- Emory University School of Medicine, Atlanta, GA, United States; Department of Radiology and Imaging Sciences, Emory University, Atlanta, GA, United States; Department of Neurology, Emory University, Atlanta, GA, United States.
| | - Brendan P Lovasik
- Emory University School of Medicine, Atlanta, GA, United States; Department of Surgery, Emory University, Atlanta, GA, United States.
| | - Marc D Benayoun
- Emory University School of Medicine, Atlanta, GA, United States; Department of Radiology and Imaging Sciences, Emory University, Atlanta, GA, United States.
| | | | - Chad A Holder
- Emory University School of Medicine, Atlanta, GA, United States; Department of Radiology and Imaging Sciences, Emory University, Atlanta, GA, United States.
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Yamada M, Abiko M. [Complete Transection of the Cervical Trachea Caused by Chest Blunt Trauma]. Kyobu Geka 2016; 69:1081-1085. [PMID: 27909277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
A 52-year-old man was injured when driving through the gate by a motorcycle without noticing the rope between the gateposts. He developed hoarseness, subcutaneous emphysema and dyspnea, and was transferred to our hospital by an ambulance. Chest X-ray and computed tomography showed subcutaneous and mediastinal emphysema, and complete transection of the cervical trachea. Since respiratory distress progressed rapidly, we performed tracheostomy in the intensive care unit, and the patient was carried to the operating room. Tracheoplasty was performed with 3-0 prolene. The postoperative course was satisfactory except for bilateral recurrent nerve palsy.
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Affiliation(s)
- Masahiro Yamada
- Department of Thoracic Surgery, Okitama General Hospital, Yamagata, Japan
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37
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Reihani H, Mahmoudi V, Abbasi B, Akhavan R. A Young Woman with Puffy Face. J Emerg Med 2016; 51:e97-e99. [PMID: 27545855 DOI: 10.1016/j.jemermed.2016.05.051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2016] [Accepted: 05/27/2016] [Indexed: 06/06/2023]
Affiliation(s)
- Hamidreza Reihani
- Department of Emergency Medicine, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Vahid Mahmoudi
- Department of Emergency Medicine, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Bita Abbasi
- Department of Radiology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Reza Akhavan
- Department of Emergency Medicine, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
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38
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Affiliation(s)
- Menachem Gross
- Department of Otolaryngology-Head and Neck Surgery, Hadassah University Hospital, Jerusalem, Israel
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39
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Cho SH, Lee HC, Park CW. CT angiography with 3D reconstruction for the initial evaluation of penetrating neck injury with retained knife. Otolaryngol Head Neck Surg 2016; 136:504-5. [PMID: 17321892 DOI: 10.1016/j.otohns.2006.08.015] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2006] [Indexed: 11/19/2022]
Affiliation(s)
- Seok Hyun Cho
- Department of Otolaryngology-Head and Neck Surgery, School of Medicine, Hanyang University, Seoul, Korea
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40
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Fuglsang M, Agger A. [The need for clinical examination in penetrating neck trauma]. Ugeskr Laeger 2015; 177:V12130707. [PMID: 26320357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
In this case report we present a 52-year-old male with a sharp, penetrating neck trauma. We discuss the need for surgical neck exploration and the use of ultrasound and CT-scans when evaluating the extent of the injury.
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Affiliation(s)
- Milos Fuglsang
- Øre-næse-hals-afdeling H, Aarhus Universitetshospital, Nørrebrogade 44, 8000 Aarhus C.
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Zhang B, Cai X, Ding R, Kang H. [RESEARCH PROGRESS OF DIAGNOSIS AND TREATMENT OF HANGMAN FRACTURE]. Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi 2015; 29:513-517. [PMID: 26477169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
OBJECTIVE To review the research progress of the diagnosis and treatment of Hangman fracture. METHODS The original articles about the diagnosis and treatment of Hangman fracture were extensively reviewed and analyzed. RESULTS Not only X-ray, but also MRI and CT scans are necessory for the diagnosis and assessment of Hangman fractures. The treatment of unstable Hangman fracture included posterior C2, C3 fixation, anterior C2, C3 fixation, and anterior C2, C3 fixation combined with posterior C2 pedicle screw fixation. The anterior surgical fixation is used by the anterior retropharyngeal approach or subaxial anterior approach, and it has the advantages of directly resecting the injured C2, C3 discs, getting a satisfactory cervical spine alignment, and avoiding the postoperative axial pain. However, posterior surgical fixation using C2 pedicle screw has the risks of neurovascular injuries. CONCLUSION The surgical technique of Hangman fracture should be determined based on the patient's injury and surgeon's experience. Randomized control trials of different surgical techniques should be performed.
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Laosuwan P, Earsakul A, Numkarunarunrote N, Khamjaisai J, Charuluxananan S. Randomized cinefluoroscopic comparison of cervical spine motion using McGrath series 5 and Macintosh laryngoscope for intubation with manual in-line stabilization. J Med Assoc Thai 2015; 98 Suppl 1:S63-S69. [PMID: 25764615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
BACKGROUND Intubation in patients with suspected cervical spine injury must be cautiously performed to avoid any further neurologic trauma. Several intubation techniques have been introduced to minimize cervical spine motion such as the use of the videolaryngoscope. OBJECTIVE The present study aims to compare the movement of the cervical spine during intubation by using McGrath series 5 videolaryngoscope (MGL) and that of the conventional Macintosh laryngoscope from cinefluoroscopic imaging. MATERIAL AND METHOD Twenty-two patients undergoing elective orthopedic surgery that did not involve cervical spine procedure and required general anesthesia were recruited into the study. All patients were randomized either to have intubation with MGL (n = 11) or Macintosh laryngoscope (n = 11) in a neutral position with manual in-line stabilization (MILS). The primary outcome was the cervical vertebral angle changes pre- and post-intubation, measured by cinefluoroscopy. The number of intubation attempts, the laryngoscopic view, the time to intubation, and the incidence ofany complications were recorded as well. RESULTS Eleven patients were included in each group without any exclusion from the study. The cervical vertebral angle changes pre- and post-intubation with the MGL was less than with the Macintosh laryngoscope at C3/4 (2.00 vs. 4.27 degrees, respectively; p-value = 0.034) and the cumulative changes of all cervical spine levels (9.18 vs. 17.18 degrees, respectively; p-value = 0.017). However, the time to intubation with the MGL was longer (35.07 vs. 23.21 seconds, p-value = 0.004), the laryngoscope view was better. There were no statistically significant differences in the intubation success rate, the number of attempts, and the incidence of complications. CONCLUSION Orotracheal intubation with MGL provided less cervical spine motion and improved visualization of the vocal cords, without causing adverse consequences as compared with Macintosh laryngoscope and MILS.
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Desai NK, Kang J, Chokshi FH. Screening CT angiography for pediatric blunt cerebrovascular injury with emphasis on the cervical "seatbelt sign". AJNR Am J Neuroradiol 2014; 35:1836-40. [PMID: 24722311 DOI: 10.3174/ajnr.a3916] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE There are no standard screening guidelines to evaluate blunt cerebrovascular injury in children. The purpose of this retrospective study was to understand the clinical and radiologic risk factors associated with pediatric blunt cerebrovascular injury on CTA of the neck with primary attention to the cervical "seatbelt sign." MATERIALS AND METHODS Radiology reports from 2002 to 2012 were queried for the examination "CTA neck." The electronic medical record was reviewed for mechanism of injury, Glasgow Coma Scale score, and physical examination findings. Radiology reports from adjunct radiographic studies were reviewed. CTA neck examinations with reported blunt cerebrovascular injury were reviewed to confirm imaging findings. Patients with penetrating injury or those without a history of trauma were excluded. RESULTS Four hundred sixty-three patients underwent CTA of the neck; 137 had blunt trauma. Forty-two of 85 patients involved in a motor vehicle collision had a cervical seatbelt sign; none had blunt cerebrovascular injury. Nine vessels (4 vertebral arteries, 4 ICAs, 1 common carotid artery) in 8 patients ultimately were diagnosed with various grades (I-IV) of blunt cerebrovascular injury, representing 5.8% (8/137) of the population screened for blunt neck trauma. The mean Glasgow Coma Scale score was significantly lower (P=.02) in the blunt cerebrovascular injury group versus the non-blunt cerebrovascular injury group. Although not statistically significant, patients with blunt cerebrovascular injury had a higher tendency to have additional traumatic injuries, primarily basilar skull fractures (P=.05) and intracranial hemorrhage (P=.13). CONCLUSIONS A common indication for neck CTA, the cervical seatbelt sign, was not associated with blunt cerebrovascular injury. With the exception of Glasgow Coma Scale score, no single risk factor was statistically significant in predicting vascular injury in this series.
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Affiliation(s)
- N K Desai
- From the Division of Neuroradiology (N.K.D.), Department of Radiology and Imaging Sciences, Emory University School of Medicine, Children's Healthcare of Atlanta, Atlanta, Georgia
| | - J Kang
- Department of Biostatistics and Bioinformatics (J.K.), Department of Radiology and Imaging Sciences, Emory University School of Medicine and Rollins School of Public Health, Atlanta, Georgia
| | - F H Chokshi
- Division of Neuroradiology (F.H.C.), Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia
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Ge C, Hao D, He B, Liu T, Wang X, Wu Q. [EFFECTIVENESS OF ANTERIOR CERVICAL PLATE FIXATION FOR UNSTABLE Hangman FRACTURE]. Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi 2014; 28:728-732. [PMID: 26455227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
OBJECTIVE To explore the effectiveness of anterior cervical plate internal fixation in the treatment of unstable Hangman fracture. METHODS Between May 2006 and May 2010, 42 patients with unstable Hangman fracture were treated by anterior cervical plate internal fixation. There were 30 males and 12 females with an average age of 36.5 years (range, 22-64 years). According to the Levine-Edwards classification, 25 cases were rated as type II, 15 cases as type II A, and 2 cases as type III. Eight patients had spinal cord injury. The average interval between injury and operation was 5 days (range, 3-14 days). The X-ray, CT, and MRI were done pre- and post-operatively to evaluate the cervical physiological curvature, the intervertebral disc height of C2, 3, the fracture-healing, and bone fusion. The effectiveness was evaluated using visual analogue scale (VAS) for occipitocervical pain, Neck Disability Index (NDI) for cervical spine function, and the Japanese Orthopaedic Association (JOA) score for neurological functional recovery. RESULTS All incisions healed by first intention. No neurological deterioration or internal fixation failure was observed. All of the patients were followed up 2-5 years (mean, 3.5 years). The complications were dysdipsia in 3 cases and dysphagia in 4 cases, which alleviated spontaneously after 1 week. All the patients were almost free from occipitocervical pain and the limited cervical spine motion. Neurological function was improved in 8 cases of spinal cord injury, and complete decompression was observed in 6 cases who had spinal cord compression. The bone fusion was observed at 6.5 months on average (range, 6-8 months); the mean fracture-healing time was 10.5 months (range, 9-12 months). The VAS, NDI, and JOA scores were significantly improved at 3 months after operation and last follow-up when compared with preoperative scores (P < 0.05), significant improvement scores were achieved at last follow-up when compared with the scores at 3 months (P < 0.05). The intervertebral disc height of C2, 3, the reconstructed curvature and stability of the cervical spine, and the spine movement were good. CONCLUSION The method of anterior cervical plate internal fixation can achieve satisfactory reduction and fusion, less complications, negligible impact on the cervical movement. So it is an ideal method to treat unstable Hangman fracture.
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Adelgais KM, Browne L, Holsti M, Metzger RR, Murphy SC, Dudley N. Cervical spine computed tomography utilization in pediatric trauma patients. J Pediatr Surg 2014; 49:333-7. [PMID: 24528980 DOI: 10.1016/j.jpedsurg.2013.10.006] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2013] [Accepted: 10/09/2013] [Indexed: 11/15/2022]
Abstract
BACKGROUND Guidelines for evaluating the cervical spine in pediatric trauma patients recommend cervical spine CT (CSCT) when plain radiographs suggest an injury. Our objective was to compare usage of CSCT between a pediatric trauma center (PTC) and referral general emergency departments (GEDs). METHODS Patient data from a pediatric trauma registry from 2002 to 2011 were analyzed. Rates of CSI and CSCT of patients presenting to the PTC and GED were compared. Factors associated with use of CSCT were assessed using multivariate logistic regression. RESULTS 5148 patients were evaluated, 2142 (41.6%) at the PTC and 3006 (58.4%) at the GED. Groups were similar with regard to age, gender, GCS, and triage category. GED patients had a higher median ISS (14 vs. 9, p<0.05) and more frequent ICU admissions (44.3% vs. 26.1% p<0.05). CSI rate was 2.1% (107/5148) and remained stable. CSCT use increased from 3.5% to 16.1% over time at the PTC (mean 9.6% 95% CI=8.3, 10.9) and increased from 6.8% to 42.0% (mean 26.9%, CI=25.4, 28.4) at the GED. Initial care at a GED remained strongly associated with CSCT. CONCLUSIONS Despite a stable rate of CSI, rate of CSCT increased significantly over time, especially among patients initially evaluated at a GED.
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Affiliation(s)
- Kathleen M Adelgais
- Department of Pediatrics, Section of Pediatric Emergency Medicine, University of Colorado Denver School of Medicine, Aurora, CO.
| | - Lorin Browne
- Department of Pediatrics, Pediatric Emergency Medicine Section, Medical College of Wisconsin, Milwaukee, WI
| | - Maija Holsti
- Department of Pediatrics, Division of Pediatric Emergency Medicine, University of Utah, Salt Lake City, UT
| | - Ryan R Metzger
- Department of Surgery, Division of Pediatric Surgery, University of Utah, Salt Lake City, UT
| | | | - Nanette Dudley
- Department of Pediatrics, Division of Pediatric Emergency Medicine, University of Utah, Salt Lake City, UT
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Pickett W, Kukaswadia A, Thompson W, Frechette M, McFaull S, Dowdall H, Brison RJ. Use of diagnostic imaging in the emergency department for cervical spine injuries in Kingston, Ontario. CAN J EMERG MED 2014; 16:25-33. [PMID: 24423998 DOI: 10.2310/8000.2013.131051] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVES This study assessed the use and clinical yield of diagnostic imaging (radiography, computed tomography, and medical resonance imaging) ordered to assist in the diagnosis of acute neck injuries presenting to emergency departments (EDs) in Kingston, Ontario, from 2002-2003 to 2009-2010. METHODS Acute neck injury cases were identified using records from the Kingston sites of the Canadian National Ambulatory Care Reporting System. Use of radiography was analyzed over time and related to proportions of cases diagnosed with clinically significant cervical spine injuries. RESULTS A total of 4,712 neck injury cases were identified. Proportions of cases referred for diagnostic imaging to the neck varied significantly over time, from 30.4% in 2002-2003 to 37.6% in 2009-2010 (ptrend = 0.02). The percentage of total cases that were positive for clinically significant cervical spine injury ("clinical yield") also varied from a low of 5.8% in 2005-2006 to 9.2% in 2008-2009 (ptrend = 0.04), although the clinical yield of neck-imaged cases did not increase across the study years (ptrend = 0.23). Increased clinical yield was not observed in association with higher neck imaging rates whether that yield was expressed as a percentage of total cases positive for clinically significant injury (p = 0.29) or as a percentage of neck-imaged cases that were positive (p = 0.77). CONCLUSIONS We observed increases in the use of diagnostic images over time, reflecting a need to reinforce an existing clinical decision rule for cervical spine radiography. Temporal increases in the clinical yield for total cases may suggest a changing case mix or more judicious use of advanced types of diagnostic imaging.
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Satahoo SS, Davis JS, Garcia GD, Alsafran S, Pandya RK, Richie CD, Habib F, Rivas L, Namias N, Schulman CI. Sticking our neck out: is magnetic resonance imaging needed to clear an obtunded patient's cervical spine? J Surg Res 2013; 187:225-9. [PMID: 24157265 DOI: 10.1016/j.jss.2013.09.022] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2013] [Revised: 08/20/2013] [Accepted: 09/18/2013] [Indexed: 11/20/2022]
Abstract
BACKGROUND Evaluating the cervical spine in the obtunded trauma patient is a subject fraught with controversy. Some authors assert that a negative computed tomography (CT) scan is sufficient. Others argue that CT alone misses occult unstable injuries, and magnetic resonance imaging (MRI) will alter treatment. This study examines the data in an urban, county trauma center to determine if a negative cervical spine CT scan is sufficient to clear the obtunded trauma patient. METHODS Records of all consecutive patients admitted to a level 1 trauma center from January 2000 to December 2011 were retrospectively analyzed. Patients directly admitted to the intensive care unit with a Glasgow Coma Scale score ≤13, contemporaneous CT and MRI, and a negative CT reading were included. The results of the cervical spine MRI were analyzed. RESULTS A total of 309 patients had both CT and MRI, 107 (35%) of whom had negative CTs. Mean time between CT and MRI was 16 d. Of those patients, seven (7%) had positive acute traumatic findings on MRI. Findings included ligamentous injury, subluxation, and fracture. However, only two of these patients required surgical intervention. None had unstable injuries. CONCLUSIONS In the obtunded trauma patient with a negative cervical spine CT, obtaining an MRI does not appear to significantly alter management, and no unstable injuries were missed on CT scan. This should be taken into consideration given the current efforts at cost-containment in the health care system. It is one of the larger studies published to date.
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Affiliation(s)
- Shevonne S Satahoo
- Division of Trauma and Critical Care, DeWitt Daughtry Department of Surgery, Jackson Memorial Hospital/University of Miami - Miller School of Medicine, Miami, Florida
| | - James S Davis
- Division of Trauma and Critical Care, DeWitt Daughtry Department of Surgery, Jackson Memorial Hospital/University of Miami - Miller School of Medicine, Miami, Florida
| | - George D Garcia
- Division of Trauma and Critical Care, DeWitt Daughtry Department of Surgery, Jackson Memorial Hospital/University of Miami - Miller School of Medicine, Miami, Florida
| | - Salman Alsafran
- Division of Trauma and Critical Care, DeWitt Daughtry Department of Surgery, Jackson Memorial Hospital/University of Miami - Miller School of Medicine, Miami, Florida
| | - Reeni K Pandya
- Division of Trauma and Critical Care, DeWitt Daughtry Department of Surgery, Jackson Memorial Hospital/University of Miami - Miller School of Medicine, Miami, Florida
| | - Cheryl D Richie
- Division of Trauma and Critical Care, DeWitt Daughtry Department of Surgery, Jackson Memorial Hospital/University of Miami - Miller School of Medicine, Miami, Florida
| | - Fahim Habib
- Division of Trauma and Critical Care, DeWitt Daughtry Department of Surgery, Jackson Memorial Hospital/University of Miami - Miller School of Medicine, Miami, Florida
| | - Luis Rivas
- Department of Radiology, Jackson Memorial Hospital/University of Miami - Miller School of Medicine, Miami, Florida
| | - Nicholas Namias
- Division of Trauma and Critical Care, DeWitt Daughtry Department of Surgery, Jackson Memorial Hospital/University of Miami - Miller School of Medicine, Miami, Florida
| | - Carl I Schulman
- Division of Trauma and Critical Care, DeWitt Daughtry Department of Surgery, Jackson Memorial Hospital/University of Miami - Miller School of Medicine, Miami, Florida.
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