Abstract
BackgroundClearing the cervical spine in an unconscious blunt trauma patient is an elusive concept. The aim of this study was to describe the incidence of cervical spine injury (CSI) in patients with a traumatic brain injury (TBI). The study was conducted on patients who underwent imaging of both the cervical spine and the brain in one sitting at a busy government healthcare facility in Pietermaritzburg.MethodsThis was a retrospective, cross sectional study of all the trauma patients presenting to a regional hospital emergency department (ED) in the KwaZulu-Natal (KZN) Province, who underwent computed tomography (CT) imaging of the brain and the cervical spine in one sitting during the period January 2016 to June 2016.ResultsAdult males formed the majority (78.9%) of the study population and had the highest incidence of TBI, the most common identified pathology in CT being parenchymal injuries (41%). The mechanisms that resulted in the majority of injuries sustained were assault (38.7%) and motor vehicle collisions (MVCs) (25%), while seven patients (4.76%) had a combined diagnosis of TBI and CSI. The average Glasgow Coma Scale (GCS) was 12.ConclusionYoung adult males are at the greatest risk of sustaining TBI, with assault being the most common mechanism of injury. Combined diagnoses of TBI and CSI are rare and were mostly noted in patients involved in MVCs and pedestrian vehicle collisions. While the chance of an abnormal CT scan increased with a decreasing GCS score, 33% of patients with a mild TBI did not have abnormal CT findings, and 25% patients with severe TBI had no abnormal CT findings.
Highlights
Trauma continues to be a major cause of morbidity and mortality worldwide, with the World Health Organisation (WHO) estimating in 2012 that trauma-related deaths caused 9% of global mortalities.[1]
Patients with a moderate traumatic brain injury (TBI) have a greater chance of an abnormal finding than patients with a mild TBI
Patients with a severe TBI have a greater chance of an abnormal finding than patients with a mild TBI
Summary
Trauma continues to be a major cause of morbidity and mortality worldwide, with the World Health Organisation (WHO) estimating in 2012 that trauma-related deaths caused 9% of global mortalities.[1]. Traumatic brain injury is most frequently classified into three distinct categories, that is, mild (13–15), moderate (9–12) and severe (< 8), according to the Glasgow Coma Scale (GCS), which is a neurological scale that was designed to objectively assess impaired consciousness.[3] In addition, Advanced Trauma Life Support (ATLS) teaches that a GCS less than 8 necessitates intubation and this is applied to South African trauma facilities. Severe CSIs are of particular concern regarding trauma, as they carry a high morbidity and are often associated with TBI, both being reported in 74% of patients.[4]. The aim of this study was to describe the incidence of cervical spine injury (CSI) in patients with a traumatic brain injury (TBI).
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Schedule a callMore From: South African family practice : official journal of the South African Academy of Family Practice/Primary Care
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