PMID- 11990836
OWN - NLM
STAT- MEDLINE
DCOM- 20020528
LR  - 20190910
IS  - 0022-3085 (Print)
IS  - 0022-3085 (Linking)
VI  - 96
IP  - 3 Suppl
DP  - 2002 Apr
TI  - Cervical spine trauma associated with moderate and severe head injury: incidence, 
      risk factors, and injury characteristics.
PG  - 285-91
AB  - OBJECT: Diagnosing and managing cervical spine trauma in head-injured patients is 
      problematic due to an altered level of consciousness in such individuals. The 
      reported incidence of cervical spine trauma in head-injured patients has 
      generally ranged from 4 to 8%. In this retrospective study the authors sought to 
      define the incidence of cervical injury in association with moderate or severe 
      brain injury, emphasizing the identification of high-risk patients. METHODS: The 
      study included 447 consecutive moderately (209 cases) or severely (238 cases) 
      head injured patients who underwent evaluation at two Level 1 trauma centers over 
      a 40-month period. Of the 447 patients, 24 (5.4%) suffered a cervical spine 
      injury (17 men and seven women; mean age 39 years; median Glasgow Coma Scale 
      [GCS] score of 6, range 3-14). Of these 24 patients, 14 (58.3%) sustained spinal 
      cord injuries (SCIs), 14 sustained injuries in the occiput-C3 region, and 10 
      underwent a stabilization procedure. Of the 14 patients with SCIs, nine 
      experienced an early hypotensive and/or hypoxic insult. Regarding the mechanism 
      of injury, cervical injuries occurred in 21 (8.2%) of 256 patients involved in 
      motor vehicle accidents (MVAs), either as passengers or pedestrians, compared 
      with three (1.6%) of 191 patients with non-MVA-associated trauma (p < 0.01). In 
      the subset of 131 MVA passengers, 13 (9.9%) sustained cervical injuries. Patients 
      with an initial GCS score less than or equal to 8 were more likely to sustain a 
      cervical injury than those with a score higher than 8 (odds ratio [OR] 2.77, 95% 
      confidence interval [CI] = 1.11-7.73) and were more likely to sustain a cervical 
      SCI (OR 5.5, 95% CI 1.22-24.85). At 6 months or more postinjury, functional 
      neurological recovery had occurred in nine patients (37.5%) and eight (33.3%) had 
      died. CONCLUSIONS: Head-injured patients sustaining MVA-related trauma and those 
      with an initial GCS score less than or equal to 8 are at highest risk for 
      concomitant cervical spine injury. A disproportionate number of these patients 
      sustain high cervical injuries, the majority of which are mechanically unstable 
      and involve an SCI. The development of safer and more rapid means of determining 
      cervical spine integrity should remain a high priority in the care of 
      head-injured patients.
FAU - Holly, Langston T
AU  - Holly LT
AD  - Department of Surgery, University of California at Los Angeles Center for Health 
      Sciences, 90095-7039, USA.
FAU - Kelly, Daniel F
AU  - Kelly DF
FAU - Counelis, George J
AU  - Counelis GJ
FAU - Blinman, Thane
AU  - Blinman T
FAU - McArthur, David L
AU  - McArthur DL
FAU - Cryer, H Gill
AU  - Cryer HG
LA  - eng
GR  - NS30308/NS/NINDS NIH HHS/United States
GR  - R49/CCR903622/CC/ODCDC CDC HHS/United States
PT  - Journal Article
PT  - Research Support, U.S. Gov't, P.H.S.
PL  - United States
TA  - J Neurosurg
JT  - Journal of neurosurgery
JID - 0253357
SB  - IM
MH  - Adolescent
MH  - Adult
MH  - Brain Injuries/*complications/epidemiology/physiopathology
MH  - Cervical Vertebrae/*injuries/physiopathology
MH  - Female
MH  - Glasgow Coma Scale
MH  - Humans
MH  - Incidence
MH  - Male
MH  - Middle Aged
MH  - Recovery of Function/physiology
MH  - Retrospective Studies
MH  - Risk Factors
MH  - Severity of Illness Index
MH  - Spinal Cord Injuries/epidemiology/*etiology/physiopathology
EDAT- 2002/05/07 10:00
MHDA- 2002/05/29 10:01
CRDT- 2002/05/07 10:00
PHST- 2002/05/07 10:00 [pubmed]
PHST- 2002/05/29 10:01 [medline]
PHST- 2002/05/07 10:00 [entrez]
AID - 10.3171/spi.2002.96.3.0285 [doi]
PST - ppublish
SO  - J Neurosurg. 2002 Apr;96(3 Suppl):285-91. doi: 10.3171/spi.2002.96.3.0285.