Abstract
GB is a 25-year-old male who presents after an all terrain vehicle (ATV) accident. At the scene the patient demonstrates a GCS score of 12 complaining of chest pain and is placed in a cervical collar. The patient presents to the local emergency room via EMS. On primary survey the patient demonstrates a flail chest and is hemodynamically unstable. In the trauma bay the patient is intubated and stabilized hemodynamically. His CXR demonstrates multiple rib fractures and a hemothorax. A left-sided chest tube is placed. Secondary survey is negative.
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References
McCaig LF, Ly N. National Hospital Ambulatory Medical Care Survey: 2000 emergency department summary. Advance data from vital and health statistics. No. 326. Hyattsville, Md.: National Center for Health Statistics, 2002. (DHHS publication no. (PHS) 2002-1250 02-0259.)
Roberge RJ, Wears RC. Evaluation of neck discomfort, neck tenderness, and neurologic deficits as indicators for radiography in blunt trauma victims. J Emerg Med. 1992;10:539–44.
Marshall LF, Knowlton S, Garfin SR, et al. Deterioration following spinal cord injury. A multicenter study. J Neurosurg. 1987;66:400–4.
Morris CG, McCoy E. Clearing the cervical spine in unconscious polytrauma victims, balancing risks and effective screening. Anaesthesia. 2004;59:464–82.
American College of Surgeons: American College of Surgeons Committee on Trauma. Advanced trauma life support: ATLS. 7th ed. Chicago, IL: American College of Surgeons; 2004.
ASIA. Standards for neurological classification of spinal injury. Chicago: American Spinal Injury Association; 1996.
Stauffer ES. Neurologic recovery following injuries to the cervical spinal cord and nerve roots. Spine. 1984;9:532–4.
Kiwerski J, Weiss M. Neurological improvement in traumatic injuries of cervical spinal cord. Paraplegia. 1981;19:31–7.
Duane TM, Dechert T, Wolfe LG, et al. Clinical examination and its reliability in identifying cervical spine fractures. J Trauma. 2007;62:1405–8.
Gonzalez RP, Fried PO, Bukhalo M, et al. Role of clinical examination in screening for blunt cervical spine injury. J Am Coll Surg. 1999;189:152–7.
Stiell IG, Clement CM, McKnight RD, et al. The Canadian C-spine rule versus the NEXUS low-risk criteria in patients with trauma. N Engl J Med. 2003;349:2510–8.
Hoffman JR, Mower WR, Wolfson AB, et al. Validity of a set of clinical criteria to rule out injury to the cervical spine in patients with blunt trauma: National Emergency X-Radiography Utilization Study Group. N Engl J Med. 2000;343:94–9.
Stiell IG, Wells GA, Vandemheen KL, et al. The Canadian C-spine rule for radiography in alert and stable trauma patients. JAMA. 2001;286:1841–8.
Tontz W, Anderson PA, Resnick DK. Clearance of the asymptomatic cervical spine: a meta-analysis. Spine J. 2006;6:60S.
Daffner RH, Hackney DB. ACR appropriateness criteria on suspected spine trauma. J Am Coll Radiol. 2007;4:762–75.
Hadley MN. Radiographic assessment of the cervical spine in asymptomatic trauma patients. Neurosurgery. 2002;50(3 suppl):S30–5.
France JC. Update on the appropriate radiographic studies for cervical spine Evaluation and clearance in the polytraumatized patient. Curr Orthop Pract. 2008;19:411–5.
Milby AH, Halpern CH, Guo W, et al. Prevalence of cervical spinal injury in trauma. Neurosurg Focus. 2008;25:E10.
Menaker J, Philp A, Boswell S, et al. Computed tomography alone for cervical spine clearance in the unreliable patient: are we there yet? J Trauma. 2008;64:898–903.
Muchow RD, Resnick DK, Abdel MP, et al. Magnetic resonance imaging (MRI) in the clearance of the cervical spine in blunt trauma: a meta-analysis. J Trauma. 2008;64:179–89.
Stassen NA, Williams VA, Gestring ML, et al. Magnetic resonance imaging in combination with helical computed tomography provides a safe and efficient method of cervical spine clearance in the obtunded trauma patient. J Trauma. 2006;60:171–7.
Grossman MD, Reilly PM, Gillett T, et al. National survey of the incidence of cervical spine injury and approach to cervical spine clearance in U.S. trauma centers. J Trauma. 1999;47:684–90.
Burrney RE, Maio RF, Maynard F, et al. Incidence, characteristics, and outcome of spinal cord injury at trauma centers in North America. Arch Surg. 1993;128:596–9.
Blackmore CC, Emerson SS, Mann FA, et al. Cervical spine imaging in patients with trauma: determination of fracture risk to optimize use. Radiology. 1999;211:759–65.
Parsons KC. The impact of spinal cord injury on long term survival. J Insur Med. 1991;23:227.
Parsons KC, Lammertse DP. Rehabilitation in spinal cord disorders. 1. Epidemiology, prevention, and system of care of spinal disorders. Arch Phys Med Rehabil. 1991;72:S293–294.
Anderson PA, Muchow RD, Munoz A, et al. Clearance of the asymptomatic cervical spine: a meta-analysis. J Orthop Trauma. 2010;24:100–6.
Hoffman JR, Schriger DL, Mower W, et al. Low-risk criteria for cervical-spine radiography in blunt trauma: a prospective study. Ann Emerg Med. 1992;21:1454–60.
Mahadevan S, Mower WR, Hoffman JR, et al. Interrater reliability of cervical spine injury criteria in patients with blunt trauma. Ann Emerg Med. 1998;31:197–201.
Hoffman JR, Wolfson AB, Todd K, et al. Selective cervical spine radiography in blunt trauma: methodology of the National Emergency X-Radiography Utilization Study (NEXUS). Ann Emerg Med. 1998;32:461–9.
Bandiera G, Stiell IG, Wells GA, et al. The Canadian C-Spine Rule performs better than unstructures physician judgement. Ann Emerg Med. 2003;42:395–402.
Stiell IG, Wells GA, McKnight RD, et al. Canadian C-Spine Rule study for alert and stable trauma patients. I. Background and rationale. Can J Emerg Med. 2002;4:84–90.
Idem. Canadian C-Spine Rule study for alert and stable trauma patients. II. Study objectives and methodology. Can J Emerg Med. 2002;4:185–93.
Como JJ, Diaz JJ, Dunham CM, et al. Practice management guidelines for identification of cervical spine injuries following trauma: update from the eastern association for the surgery of trauma practice management guidelines committee. J Trauma. 2009;67:651–9.
Harris MB, Sethi RK. The initial assessment and management of the multiple-trauma patient with an associated spine injury. Spine (Phila Pa 1976). 2006;31(11 suppl):S9–S15.
Holmes JF, Akkinepalli R. Computed tomography versus plain radiography to screen for cervical spine injury: a metaanalysis. J Trauma. 2005;58:902–5.
Gale SC, Gracias VH, Reilly PM, et al. The inefficiency of plain radiography to evaluate the cervical spine after blunt trauma. J Trauma. 2005;59:1121–5.
Bachulis BL, Long WB, Hynes GD, et al. Clinical indications for cervical spine radiographs in the traumatized patient. Am J Surg. 1987;153:473–8.
Radiographic assessment of the cervical spine in symptomatic trauma patients. Neurosurgery. 2002;50:S36–S43.
MacDonald RL, Schwartz ML, Mirich D, et al. Diagnosis of cervical spine injury in motor vehicle crash victims: how many X-rays are enough? J Trauma. 1990;30:392–7.
Brown CV, Antevil JL, Sise MJ, et al. Spiral computed tomography for the diagnosis of cervical, thoracic, and lumbar spine fractures: its time has come. J Trauma. 2005;58:890–5.
Hennessy D, Widder S, Zygun D, et al. Cervical spine clearance in obtunded blunt trauma patients: a prospective study. J Trauma. 2010;68:576–82.
McCulloch PT, France J, Jones DL, et al. Helical computed tomography alone compared with plain radiographs with adjunct computed tomography to evaluate the cervical spine after high energy trauma. J Bone Joint Surg Am. 2005;87:2388–94.
Grogan EL, Morris Jr JA, Dittus RS, et al. Cervical spine evaluation in urban trauma centers: lowering institutional costs and complications through helical CT scan. J Am Coll Surg. 2005;200:160–5.
Khan SN, Erickson G, Sena MJ, Gupta MC. Use of flexion and extension radiographs of the cervical spine to rule out acute instability in patients with negative computed tomography scans. J Orthop Trauma. 2011;1:51–6.
Wadhwa R, Shamieh S, Haydel J, et al. The role of flexion and extension computed tomography with reconstruction in clearing the cervical spine in trauma patients: a pilot study. J Neurosurg Spine. 2011;14:341–7.
Vaccaro AR, Kreidl KO, Pan W, et al. Usefulness of MRI in isolated upper cervical spine fractures in adults. J Spinal Disord. 1998;11:289–93.
Chiu WC, Haan JM, Cushing BM, et al. Ligamentous injuries of the cervical spine in unreliable blunt trauma patients: incidence, evaluation, and outcome. J Trauma. 2001;50:457–63.
Chiu WC, Haan JM, Cushing BM, et al. Ligamentous injuries of the cervical spine in unreliable blunt trauma patients: incidence, evaluation, and outcome. J Trauma. 2001;50:457–63. discussion 464.
Iida H, Tachibana S, Kitahara T, et al. Association of head trauma with cervical spine injury, spinal cord injury, or both. J Trauma. 1999;46:450–2.
Webber-Jones JE, Thomas CA, Bordeaux Jr RE. The management and prevention of rigid cervical collar complications. Orthop Nurs. 2002;21:19–25.
Laylock B. Solving the problem of pressure ulcers resulting from cervical collars. Ostomy Wound Manage. 1996;42:26–8. 30, 32–3.
Liew SC, Hill DA. Complication of hard cervical collars in multi-trauma patients. Aust N Z J Surg. 1994;64:139–40.
Powers JA. Multidisciplinary approach to occipital pressure ulcers related to cervical collars. J Nurs Care Qual. 1997;12:46–52.
Watts D, Abrahams E, MacMillan C, et al. Insult after injury: pressure ulcers in trauma patients. Orthop Nurs. 1998;17:84–91.
Papadopoulos MC, Chakraborty A, Waldron G, et al. Lesson of the week: exacerbating cervical spine injury by applying a hard collar. BMJ. 1999;319:171–2.
Ho AM, Fung KY, Joynt GM, et al. Rigid cervical collar and intracranial pressure of patients with severe head injury. J Trauma. 2002;53:1185–8.
Horodyski M, Dipaola CP, Conrad BP, et al. Cervical collars are insufficient for immobilizing an unstable cervical spine injury. J Emerg Med. 2011;41:513–9.
Harris TJ, Blackmore CC, Mirza SK, et al. Clearing the cervical spine in obtunded patients. Spine. 2008;33:1547–53.
Hogan GJ, Mirvis SE, Shanmuganathan K, Scalea TM. Exclusion of unstable cervical spine injury in obtunded patients with blunt trauma: is MR imaging needed when multi-detector row CT findings are normal? Radiology. 2005;237:106–13.
Tomycz ND, Chew BG, Chang YF, et al. MRI is unnecessary to clear the cervical spine in obtunded/comatose trauma patients: the four-year experience of a level I trauma center. J Trauma. 2008;64:1258–63.
Simon JB, Schoenfeld AJ, Ketz JN, et al. Are “normal” multidetector computed tomographic scans sufficient to allow collar removal in the trauma patient? J Trauma. 2010;68:103–8.
Menaker J, Philp A, Boswell S, Scalea TM. Computed tomography alone for cervical spine clearance in the unreliable patient: are we there yet? J Trauma. 2008;64:898–903.
Bolinger B, Shartz M, Marion D. Bedside fluoroscopic flexion and extension cervical spine radiographs for clearance of the cervical spine in comatose trauma patients. J Trauma. 2004;56:132–6.
Spiteri V, Kotnis R, Singh P, et al. Cervical dynamic screening in spinal clearance: now redundant. J Trauma. 2006;61:1171–7.
Anglen J, Metzler M, Bunn P, et al. Flexion and extension views are not cost-effective in a cervical spine clearance protocol for obtunded trauma patients. J Trauma. 2002;52:54–9.
Cox MW, McCarthy M, Lemmon G, et al. Cervical spine instability: clearance using dynamic fluoroscopy. Curr Surg. 2001;58:96–100.
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Simpson, A.K., Harris, M.B. (2013). Cervical Spine Clearance. In: Sethi, M., Jahangir, A., Obremskey, W. (eds) Orthopedic Traumatology. Springer, New York, NY. https://doi.org/10.1007/978-1-4614-3511-2_2
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