Cervical Spinal Injury Patients Research Articles

Diagnostic Value of Bedside Ultrasound for Detecting Cervical Spine Injuries in Patients with Severe Multiple Trauma

Background: Early cervical spine clearance is very important in trauma settings. Waiting for cervical spine clearance by CT scan mandates prolonged cervical spine immobilization and consequently, the delay in subsequent emergency procedures in polytrauma patients.Objectives: The study aimed to assess the value of cervical spine ultrasonography (US) for detecting cervical spine injuries in severe polytrauma patients.Methods: A cross-sectional analytical study was conducted on 172 severe polytrauma patients with Glasgow coma scale (GCS) score of 14 year) age groups.Results: Bedside US had a sensitivity of 74.5%, specificity of 97.6%, positive predictive value (PPV) of 92.1%, negative predictive value (NPV) of 91%, and accuracy of 91.3% in detecting spinal injuries in comparison with CT findings. Moreover, US had a sensitivity of 100%, specificity of 87.6, PPV of 50%, NPV of 100%, and accuracy of 88.9% in detecting spinal injuries with the movement of fractured or dislocated particles. Also, it had a sensitivity of 33.3%, specificity of 87.58, PPV of 100%, NPV of 97.2%, and accuracy of 97.2% in ≤14-year-old patients. The modality had a sensitivity of 76.2%, specificity of 94.7, PPV of 91.4%, NPV of 84.4%, and accuracy of 86.9% in > 14-year-old patients.Conclusions: The diagnostic value of bedside US was higher in adults and injured patients with the movement of fractured or dislocated particles.

Frequency of cervical spine injuries in patients with midface fractures

The aim of this retrospective cohort study was to determine the frequency and risk factors for cervical spine injury (CSI) in patients with midface fractures. Patients ≥18 years of age entered in the Massachusetts General Hospital Trauma Registry from 2007 to 2017 were identified. Those with a midface fracture, computed tomography and/or magnetic resonance imaging of the cervical spine, and complete medical records were included. There were 23,394 patients in the registry; 3950 (16.9%) had craniomaxillofacial fractures and 1822 (7.8%) had a CSI. Craniomaxillofacial fractures included fractures of the midface (n=2803, 71.0%), mandible (n=873, 22.1%), and midface plus mandible (n=274, 6.9%). The overall frequency of CSI in patients with midface fractures was 11.4% (350/3077). Patients with midface fractures had a higher risk for CSI compared to patients without a midface fracture (odds ratio 2.4, 95% confidence interval 2.1–2.4, P<0.001). In a multivariate model, nasal and orbital fractures, chest injuries, age, injury severity score, and motor vehicle crash or fall as the etiology were independent risk factors for CSI. Mortality was two times higher in subjects with CSI. Early and accurate diagnosis of CSI is a critical factor when planning the treatment of patients with these fractures.

AOSpine Subaxial Cervical Spine Injury Classification System: The Relationship Between Injury Morphology, Admission Injury Severity, and Long-Term Neurologic Outcome

The AOSpine Subaxial Cervical Spine Injury Classification System was introduced to improve communication, clinical management, and research. Here, the system was studied in relation to injury severity along with admission and long term neurologic follow-up. A retrospective study was performed in subaxial cervical spine injury patients. Morphology was classified using the AOSpine Subaxial Cervical Spine Injury Classification System. Six major morphology subtypes were selected for analysis. The American Spinal Injury Association (ASIA) motor and Abbreviated Injury Severity (AIS) scores were recorded at admission and at follow-up >6 months. Admission intramedullary lesion length (IMLL) on MRI was recorded. In all, 82 patients met criteria for analysis. The mean follow-up time was 11 months (range, 6-33 months). The were 36 patients with morphology subtypes A0, 4 with A1/A2, 9 with A3/A4, 8 with B2, 11 with B3, and 14 with C. The A1/2 subtype had the least severe injuries on admission. The C and A3/A4 subtypes had the most severe injuries. The subtype C had the lowest ASIA Motor Score (AMS) and second highest percentage of complete injuries. A3/A4 patients had the highest percentage of complete injuries on admission. At follow-up, A3/A4 patients had the lowest AMS, and 33% of patients continued to have complete injuries. C subtype injuries all converted to AIS incomplete injuries on follow-up (P= 0.04). IMLL was found to be significantly different compared across multiple morphologic subtypes. Surgical management for each morphology subtype was reported. The AOSpine Subaxial Cervical Spine Injury Classification System successfully associated injury morphology with IMLL along with admission and long-term neurologic function and recovery.

Frequency of Cervical Spine Injuries in Pediatric Craniomaxillofacial Trauma

In pediatric patients with craniomaxillofacial (CMF) trauma, evaluation for cervical spine injury (CSI) is critical, but there are no studies investigating CSI in this unique population. The aim of this study was to measure the frequency of CSI in the pediatric CMF fracture population. A retrospective cohort study of all pediatric patients who presented to the Johns Hopkins Hospital Emergency Department (Baltimore, MD) with CMF fractures were examined for concurrent CSIs. Patient charts were reviewed for mechanism of injury, type and level of CSI, type and location of CMF fracture patterns, and overall outcome. Data were analyzed for correlation and statistical relevance. A total of 2,966 pediatric patients (1,897 boys [64.0%]; age range, 0 to 15yr; average age, 7±4.73yr) were identified from 1990 to 2010 to have CMF fractures. Of these patients, only 5 children were found to have concomitant CSIs (frequency, 0.169%). The frequency of CSI in patients with CMF fracture and deciduous, mixed, and permanent dentition was 0, 0.307, and 0.441%, respectively. Of the 5 identified cases, 4 had concomitant middle-third facial skeletal fracture, 4 had concomitant upper-third cranial skeletal fracture, and 2 had concomitant lower-third cranial skeletal fracture. CSIs in pediatric patients with CMF fracture are rare (frequency, 0.169%); this is considerably lower than the reported ranges in adults (3.69 to 24%). No child with deciduous dentition was found to have a CSI. The lack of CSI in deciduous patients with CMF fracture could be explained by the anatomic differences between pediatric and adult cervical spines and supports conservative imaging for children in this age group (level of evidence, III).

Intubation with King Vision® video laryngoscope and Macintosh laryngoscope in cervical spine injured: A randomized controlled trial

Background: Intubation of trachea with conventional laryngoscopy requires alignment of the oropharyngeal–laryngeal axis in a straight line. This causes significant movement of the cervical spine, which in case of any previous injury to the spinal cord, may be further damaged due to impingement of the cord between the broken vertebrae. King Vision® video laryngoscope due to its particular J shape and a channel to carry the tube, causes less movement of the spine and hence provides better and safer intubation conditions in patients who have cervical injury. Methods: The study was conducted in a tertiary-level orthopedic and spine center. It was a single-blind randomized control study. After obtaining permission from Hospital Ethics Committee and patient's consent, 60 patients of cervical spine injury of American Society of Anesthesiologists I-III, and normal airway anatomy, were assessed for ease and safety of intubation by – (a) King Vision® video laryngoscope and (b) Macintosh laryngoscope. The primary criteria were Intubation Difficulty Scale (IDS), while the secondary criteria were duration of intubation, heart rate, and mean arterial pressure. Results: Results were analyzed by Chi-square, Mann–Whitney, and Student t-test using SPSS software. P value was 0.05. The mean IDS in King Vision® video laryngoscope group was significantly less than Macintosh group. However, there was no statistical difference in duration of intubation and hemodynamic parameters. Conclusions: Intubation in cervical spine injury patients with neck immobilization is easier with King Vision® video laryngoscope, but duration of intubation, complication rate, and hemodynamic parameters remain the same as compared with Macintosh laryngoscope.

Determination of Early Neurological Outcome by ASIA score following Delayed Anterior Decompression and Stabilization of Lower Cervical Spine Injury

Background: Surgical management of lower cervical spine injury is a very important issue among these patients.&#x0D; Objective: The purpose of the present study was todetermine the early neurological outcome of delayed anterior decompression and stabilization of lower cervical spine injury.&#x0D; Methodology: This cross sectional study was carried out in the Department of Neurosurgery at Dhaka Medical College and Hospital, Dhaka, Bangladesh within the period of January 2010 to July 2011 for a period of one year and 6 months. Neurological outcome following anterior decompression and stabilization of lower cervical spine injury was observe. Patients presented with lower cervical spine injury were included in this prospective study. Quantification of neurologic deficit in lower cervical spine injury patients were carried out by following The American Spinal Injury Association (ASIA) impairment scale. Early neurological outcome was also assessed after operation by using ASIA impairment scale in the follow up period at one, three and six months interval.&#x0D; Result: A total of 31 patients were included in this study. Based on the ASIA impairment scale, preoperatively, 6.4 5% of the injuries were grade A, 16.13 % of the injuries were Grade B, 16.13% of the injuries were Grade C and 35.48 % of the injuries were Grade D. early post-operative complications include dysphagia in 3 5.48% cases, donor site infection in 9.67% cases, CSF leak in 3.22%; catheter related urinary tract infection 9.67% and bed sore occurred in 6.45% cases.&#x0D; Conclusion: In conclusion significant neurological recovery can be expected following delayed anterior decompression and stabilization of lower cervical spine in lower cervical spine injury patient.&#x0D; Journal of National Institute of Neurosciences Bangladesh, 2018;4(2): 82-86

Abstract: Cervical Spine Fractures in Pediatric Maxillofacial Trauma: A Single Center Retrospective Review

PURPOSE: Pediatric cervical spine injuries are uncommon events, but can be devastating injuries. Facial fractures have been associated with injuries to the cervical spine in children. The objective of this study was to describe the mechanisms, associated injuries and outcomes of pediatric cervical spine injuries in patients with known maxillofacial trauma at a level 1 trauma center. METHODS and MATERIALS: After institutional review board approval, an analysis was performed of all admissions to a single level 1 trauma center pediatric maxillofacial trauma, from 2006 to 2015. Patients were stratified based on the presence or absence of a cervical spine fracture. Data was abstracted to include demographic, mechanism and clinical outcomes data. Statistical analysis using chi-square and Mann-Whitney U tests were performed to compare these groups. RESULTS: There were 1277 patients who were admitted with maxillofacial trauma during the study period. Of these, 72 (5.6%) experienced a cervical spine injury. Factors associated with cervical spine injuries include older age (14.0 v 12.2 years, p = 0.02) and penetrating mechanism (13.8 v 5.5% p<0.01). All penetrating facial injuries associated with cervical spine injuries were secondary to gunshot wounds. Cervical spine injuries were associated with concomitant traumatic brain injuries (p<0.01) and skull fractures (p<0.01). Patients with spine injuries were more like to experience a longer length of stay (11.9 v 5.2 days, p<0.01) and death (12.5% v 3.1%, p<0.01). CONCLUSION: Our database demonstrated a 6% incidence of pediatric cervical spine injuries in patients with known maxillofacial trauma. This incidence is higher than previously published reports of smaller cohorts. Specifically, the incidence of spine trauma in our database was highest with gunshot wounds causing maxillofacial trauma. Clinicians must take care to stabilize the cervical spine in any patient with facial fractures, especially during work up and diagnostic maneuvers performed before spinal injuries are ruled out. Additionally, clinicians should maintain a high index of suspicion for cervical spine injuries in pediatric patients with trauma to the head and neck.

Risk Factors for Cervical Spine Injury in Patients With Mandibular Fractures

Patients with mandibular fractures are known to be at risk of concomitant cervical spine injuries (CSIs). The purpose of this study was to determine the incidence of and risk factors for CSIs in these patients. We conducted a retrospective cohort study of adult trauma patients with mandibular fractures from June 1, 2007, through June 30, 2017. Patients were identified through the Massachusetts General Hospital trauma registry and were included as study patients if they had a mandibular fracture and computed tomography or magnetic resonance imaging of the cervical spine. The primary predictor variable was the site of the mandibular fracture; the primary outcome variables were the presence of CSIs and death. The other variables were demographic characteristics (age, gender, alcohol use, and drug use), Injury Severity Score, Glasgow Coma Scale, presence of midface and extra-craniofacial injuries, and etiology. Data analysis consisted of univariate correlations and construction of a multivariate model to determine independent risk factors for CSIs. Of 23,394 patients in the trauma registry, 3,950 (17%) had craniomaxillofacial fractures and 1,822 (7.7%) had CSIs. The frequency of CSIs in the overall cohort of mandibular fracture patients (n=1,147) was 4.4%, and for admitted patients (n=495), it was 10%. The mean age of patients with mandibular fractures plus CSIs was 40years (range, 19 to 93years); 84% were men. Patients with a ramus-condyle unit fracture, mandibular fracture plus any midface fracture, non-craniomaxillofacial injury, and motor vehicle crash etiology had the highest frequency of CSIs. Ramus-condyle unit fractures and chest injuries were independent risk factors for CSIs in the multivariate model (P=.0334 and P=.0013, respectively). The mortality rate was 4-fold higher in patients with CSIs versus those without CSIs. The presence of ramus-condyle unit fractures and the presence of chest injuries were independent risk factors for CSIs. Oral and maxillofacial surgeons should be diligent in ruling out CSIs in mandibular fracture patients.

Development of a new clinical decision rule for cervical CT to detect cervical spine injury in patients with head or neck trauma

ObjectivePrevious cervical spine imaging decision rules have been based on positive findings on plain X-ray and are limited by lack of specificity, age restrictions and complicated algorithms. We previously derived...

Variability in Treatment for Patients with Cervical Spine Fracture and Dislocation: An Analysis of 107,152 Patients.

Cervical spine injuries are a common cause of morbidity and mortality; however, the optimal treatment of many of these injuries is debated, and previous studies have shown substantial variation in treatment. We sought to examined treatment variation in arthrodesis and halo/tong placement in cervical spine injury patients over a 12-year period. Data from the Healthcare Cost and Utilization Project National Inpatient Sample, from 2000 to 2011, were used for this study. Patients were identified with a cervical vertebral facture or dislocation based on the International Classification of Diseases, 9th Revision codes. Using χ2 analysis, spinal arthrodesis rates and halo/tong placement rates were compared between hospitals based on teaching status for patients with and without spinal cord injury (SCI). The records of 107,152 patients with cervical fractures were examined. From 2000 to 2011, the overall arthrodesis rates fell from 25.2% to 20.6% (P < 0.001), and halo/tong placement rates fell from 13.2% to 3.6% (P<0.001). In patients with cervical fracture without SCI, arthrodesis rates fell from 17.6% to 13.9% (P < 0.001), in cervical fracture patients with SCI, arthrodesis rates rose from 50.0% to 58.9% (P < 0.001), and in cervical dislocation patients, arthrodesis rates rose from 47.6% to 57.5% (P<0.001). During the 12-year period, teaching hospitals had higher arthrodesis rates compared with nonteaching hospitals for patients with cervical fractures with SCI (57.3% vs. 53.4%, P= 0.001) and higher halo/tong placement rates for patients with cervical dislocations (2.7% vs. 1.7%, P= 0.004). Individual hospital variation showed a 3.5-fold variation in arthrodesis rates in 2000 to 2002, which fell to 3.0-fold by 2009 to2011. Arthrodesis rates for cervical fracture patients significantly decreased, and arthrodesis rates for cervical dislocation and SCI patients increased from 2000 to 2011, with variability in treatment based on hospital teaching status. Rates of halo/tong placement rapidly decreased for cervical spine trauma at both teaching and nonteaching hospitals. Individual hospital treatment variation also decreased over the study period. Further clinical studies examining the optimal treatment for spine trauma may lead to continued decreases in treatment variability.

Predictive Factors of Cervical Traction based on Cervical Spine Realignment shown by Series Lateral Cervical X-ray in Subaxial Cervical Spine Injury Patients

Predictive Factors of Cervical Traction based on Cervical Spine Realignment shown by Series Lateral Cervical X-ray in Subaxial Cervical Spine Injury Patients

Refusal of cervical spine immobilization after blunt trauma: Implications for initial evaluation and management: A retrospective cohort study

IntroductionRigid cervical collars are routinely placed in the pre-hospital setting after significant blunt trauma. Patients who are deemed competent by field personnel (Glasgow Coma Scale (GCS) ≥13, no major distracting injury and not grossly intoxicated) may refuse cervical collar placement. Material and methodsA retrospective review was conducted of all adult trauma patients presenting to a Level 1 trauma center after blunt trauma with a GCS≥13 and no distracting injury or gross intoxication from January 2014 to December 2014. Pre-hospital data was collected from emergency medical service reports and hospital data from patient charts. Cervical spine injury was identified by International Classification of Disease-9th Revision codes. Patients refusing cervical spine immobilization prior to arrival are compared to those who were compliant. ResultsA total of 629 patients met inclusion criteria. Cervical spine immobilization was refused by 28 patients, while 601 complied. There were 16 cervical spine injuries (2.5%), with 3 (10.7%) in noncompliant patients and 13 (2.2%) among those who were complaint (p = 0.03). ConclusionThe incidence of cervical spine injuries in patients refusing cervical collar immobilization is higher than in compliant patients. Patients arriving for initial evaluation having refused cervical collar immobilization should be treated with caution.

LO83: Effectiveness of implementing evidence based interventions to reduce C-spine imaging in the emergency department: a systematic review

Introduction: Unnecessary imaging of adult cervical spine (C-spine) injury patients in the Emergency Department (ED) is a concern. Guidance for C-spine image ordering exists; however, the effectiveness and safety of their implementation in the ED is not well studied. This review examines their implementation and effectiveness at reducing C-spine imaging in adults presenting to the ED with stable neck trauma. Methods: Six electronic databases and the grey literature were searched. Comparative studies examining interventions to reduce C-spine imaging were eligible for inclusion. Two independent reviewers screened for study eligibility, assessed study quality, and extracted data. Data were analyzed using RevMan (Version 5.3) to explore the effectiveness of these interventions in safely reducing C-Spine radiography. Results: A total of 848 unique citations were screened of which six before-after studies and one randomized controlled trial were included. The study population varied with respect to injury severity (i.e., stability status). None of the studies were assessed as high quality. The interventions employed included locally developed guidelines and clinical decision rules, specifically the National X-radiography Utilization Study (NEXUS) criteria and the Canadian C-Spine Rule (CCR). Various implementation strategies, such as teaching sessions, pocket reminder cards, posters and computerized decision support were used. Several studies used multi-faceted interventions. Overall, of the five study groups that examined change in x-ray ordering, three groups reported a significant reduction in c-spine radiography. The remaining two showed no change in imaging. A pooled estimate of the effectiveness of the interventions was prohibited by significant heterogeneity. Conclusion: The evidence regarding the effectiveness of interventions to reduce C-spine imaging in adult ED patients with stable neck trauma is inconclusive. Given the national and international focus on improving appropriateness and reducing unnecessary imaging through campaigns such as Choosing Wisely®, additional interventional research in this field is warranted.

Cervical vertebral injuries associated with the ossification of the posterior longitudinal ligament: Imaging features.

BackgroundSpinal injuries associated with ossification of the posterior longitudinal ligament (OPLL) have been characterized. However, the imaging features of traumatic cervical spine fractures in patients with OPLL have not been assessed adequately.PurposeTo characterize the patterns of traumatic cervical spine fractures associated with different types of OPLL.Material and MethodsWe retrospectively analyzed the patterns of fractures resulting from cervical spine injury in patients with OPLL of different types and assessed the fracture patterns in patients with ankylosed segments.ResultsTwenty-six patients (23 men, 3 women; median age, 67.0 years; age range, 43–87 years) were included. Fall from a height <3 m was the most common trauma. Contiguous type OPLL was seen in 11 patients (42%), segmental type in 11 (42%), and mixed type in four (15%). Four of the contiguous OPLL and one of the mixed OPLL patients had ankylosed segments. The incidence of cervical fractures was 69% (16/26): seven (64%) in contiguous OPLL, five (46%) in segmental OPLL, and in all four patients with mixed OPLL. Unilateral interfacetal fracture-dislocation was most common (4/16); the others were bilateral interfacetal fracture-dislocation, fractures through the ankylosed segment, transdiscal fractures, isolated facet fractures, and compression fractures. Cervical fractures were exclusively observed in the C4 to C7, except in one case occurred at the C2 level.ConclusionInterfacetal fracture-dislocation in the lower cervical vertebrae constitutes the most common injury resulting from minor trauma.

Occult subaxial cervical disco-ligamentous injuries in computer tomography negative trauma patients.

Due to lack of cervical clearance consensus in literature and the devastating consequences of missed cervical injuries, Magnetic resonance imaging (MRI) of the neurologically intact symptomatic patient with negative CT scan is frequently done to rule out disco-ligamentous injuries. This study retrospectively evaluates occult disco-ligamentous injuries detected by MRI in patients with no abnormalities detected by modern multi-detector CT scanning and postulates a new theory of ligamentous stability of cervical spine. Cervical spine injury patients treated at a spinal trauma referral centre from 2010 to 2013 were retrospectively identified. Available clinical records and radiographic imaging were reviewed to find neurologically intact symptomatic patients with no identifiable acute cervical spine injury on CT scan but MRI evidence of isolated subaxial disco-ligamentous injuries. Patient demographics, injury profile, and treatment details were extracted. Subaxial Cervical Spine Injury Classification (SLIC) and Denis three-column spinal stability theory were adopted to assess stability of injuries. 316/566 cervical spinal admissions had CT and MRI scans. 11 (3.5%) CT negative patients were found to have occult discoligamentous injuries on MRI. The average age (51.1years) was not significantly different to all cervical trauma admissions (p=0.09). Eight had flexion type and three had extension type injuries. The most common mechanisms were sports and fall on flat surface. The average SLIC score was 3.1. Four patients were classified as having unstable or potentially unstable injuries (two patients each) and three of these patients were surgically managed. Subtle CT changes to indicate discoligamentous injury could be retrospectively identified in all four of these patients. CT scans alone may be inadequate for clearing occult disco-ligamentous injuries of the subaxial cervical spine in trauma. Denis three-column stability theory may be beneficial in determining stability and guiding treatment along with the SLIC system for occult discoligamentous injuries of the subaxial cervical spine.

Incidence of combined cranial and cervical spine injuries in patients with blunt minor trauma: are combined CT examinations of the head and cervical spine justified?

Background The use of computed tomography (CT) scans of the head and cervical spine has markedly increased in patients with blunt minor trauma. The actual likelihood of a combined injury of head and cervical spine following a minor trauma is estimated to be low. Purpose To determine the incidence of such combined injuries in patients with a blunt minor trauma in order to estimate the need to derive improved diagnostic guidelines. Material and Methods A total of 1854 patients were retrospectively analyzed. All cases presented to the emergency department and in all patients combined CT scans of head and cervical spine were conducted. For the following analysis, only 1342 cases with assured blunt minor trauma were included. Data acquisition covered age, sex, and presence of a head injury as well as presence of a cervical spine injury or both. Results Of the 1342 cases, 46.9% were men. The mean age was 65.6 years. CT scans detected a head injury in 116 patients; of these, 70 cases showed an intracranial hemorrhage, 11 cases a skull fracture, and 35 cases an intracranial hemorrhage as well as a skull fracture. An injury of the cervical spine could be detected in 40 patients. A combined injury of the head and cervical spine could be found in one patient. Conclusion The paradigm of the coincidence of cranial and cervical spine injuries should be revised in patients with blunt minor trauma. Valid imaging decision algorithms are strongly needed to clinically detect high-risk patients in order to save limited resources.

332 The Prevalence of Cervical Spine Injuries in Patients With Persistent Midline Tenderness in Low Mechanism Trauma Despite Initially Negative Computed Tomography

332 The Prevalence of Cervical Spine Injuries in Patients With Persistent Midline Tenderness in Low Mechanism Trauma Despite Initially Negative Computed Tomography

Dexmedetomidine provides optimum conditions during awake fiberoptic intubation in simulated cervical spine injury patients.

Background and Aims:We undertook this study to assess if a small-dose of dexmedetomidine (DEX) for conscious sedation during awake fiberoptic intubation (AFOI) in simulated cervical spine injury (CSI) patients provides optimum conditions and fulfills the need of postintubation neurological examination required in such patients. The aim was to assess the efficacy of DEX on arousability and patient's comfort during AFOI in simulated CSI patients.Material and Methods:In this prospective, randomized double-blind study, 100 American Society of Anesthesiologists Grade I-II patients aged between 18 and 65 years scheduled for elective surgery under general anesthesia underwent AFOI under conscious sedation with DEX. After locally anesthetizing the airway and applying a cervical collar, patients either received DEX 1 μg/kg over 10 min followed by 0.7 μg/kg/h maintenance infusion or normal saline in the same dose and rate during AFOI. Targeted sedation (Ramsay sedation score [RSS] ≥2) during AFOI was maintained with midazolam [MDZ] in both groups. Statistical Analysis was performed using unpaired Student's t-test, Chi-square test, Mann-Whitney test and Wilcoxon-w test.Results:The total number of patients requiring MDZ and the mean dose of MDZ required to achieve targeted sedation (RSS ≥2) was significantly less in DEX group compared to the placebo group (P < 0.001). Similarly, patient satisfaction score, heart rate, systolic, diastolic and mean arterial pressure and respiratory parameters were significantly better in DEX group (P < 0.001). Postintubation arousability in the two groups was comparable (P = 0.29).Conclusions:Dexmedetomidine provides optimum sedation without compromising airway or hemodynamic instability with better patient tolerance and satisfaction for AFOI. It also preserves patient arousability for the postintubation neurological assessment.

Missed or Delayed Cervical Spine or Spinal Cord Injuries Treated at a Tertiary Referral Hospital in Rwanda

This study was aimed at 1) reporting cases of missed cervical spine injuries treated at a tertiary-level hospital, King Faisal Hospital, Rwanda (KFH-R), and 2) identifying the causes of delaying the diagnosis. We prospectively collected data from patients with a missed or delayed cervical spine and/or cord injury treated at King Faisal Hospital, Kigali for a 12-month period (January 2012 to December 2012). The total number of cervical spine injury patients treated at our center was retrieved from the hospital admission registry. Forty-two patients with cervical spine or spinal cord injuries were treated at KFH-R in 2012, and 4 of them had a missed or delayed diagnosis. Clinical and radiologic findings of all 4 patients are presented, and the reasons for delaying diagnosis are identified. This study found that the cervical spine injuries were missed in 9.5% of the cervical spine trauma patients and resulted in a longer hospital stay for all 4 patients and severe disability in 1 patient (25%). The reasons for missed diagnoses in this study were 1) lack of cervical spine radiographic evaluation, 2) inadequate cervical spine radiographs to show the level of injury, 3) poor sensitivity of cervical spine plain radiography, 4) poor physical examination, 5) the presence of a distracting injury, and 6) poor sensitivity of radiographs and computed tomography scans for soft tissue injuries.

A bitter pill to swallow: dysphagia in cervical spine injury

BackgroundDysphagia is a common complication after cervical spine trauma with spinal cord injury. We sought to characterize the prevalence of dysphagia within a total cervical spinal injury (CSI) population, considering the implications of spinal cord injury status and age on dysphagia development. We hypothesized that while greater rates of dysphagia would be found in geriatric and spinal cord–injured subgroups, all patients presenting with CSI would be at heightened risk for swallowing dysfunction. MethodsAll trauma admissions to a level II trauma center from January 2010 to April 2014 with CSI were retrospectively reviewed. CSI was classified as any ligamentous or cervical spinous fracture with or without cord injury. Patients failing a formal swallow evaluation were considered dysphagic. The implications of dysphagia development on age and spinal cord injury status were assessed in univariate and multivariate analyses. ResultsA total of 481 patients met study inclusion criteria, of which 123 (26%) developed dysphagia. Within the dysphagic subpopulation, 90 patients (73%) were geriatric, and 23 (19%) sustained spinal cord injury. The dysphagic subpopulation was predominantly free from spinal cord injury (81%). Multivariate analyses found age (adjusted odds ratio: 1.06; 95% confidence interval 1.04–1.07; P < 0.001) and spinal cord injury (adjusted odds ratio: 2.69; 95% confidence interval 1.30–5.56; P = 0.008) to be significant predictors of dysphagia development. ConclusionsDespite spinal cord–injured patients being at increased risk for dysphagia, most of the dysphagic subpopulation was free from spinal cord injury. Geriatric and CSI patients with or without cord injury should be at heightened suspicion for dysphagia development.