Presence Of Multiple Injuries Research Articles

Hyoid Kemik Büyük Boynuz Kırığı

The primary symptom of a hyoid bone fracture is a sharp pain that increases with swallowing, coughing, and speaking in front of the neck. Closed hyoid fractures may be asymptomatic or may be missed in the presence of multiple injuries. It may cause clinical findings such as difficulty in swallowing and speaking, pain, limitation in mouth opening. Soft and hard tissue manifestations of neck trauma should be carefully evaluated. If there is a strong clinical suspicion of organ damage, ancillary diagnostic methods such as computed tomography, direct nasolaryngoscopy, pharyngoscopy, and laryngobronchoscopy may be useful to exclude or confirm the possibility of injury.

Outcomes of Flexor Tendon Repair in Patients With Concurrent Neurovascular Injuries of Multiple Digits in Zone 1

We treated several patients with multiple flexor (flexor digitorum profundus; FDP) injuries accompanied by injuries to the digital nerve or vessels around the distal interphalangeal crease (zone 1). Here, we retrospectively report the outcomes and review the literature. Between January 2010 and December 2018, 16 patients who met the study inclusion criteria were investigated. Tendons were repaired using the cross-locked cruciate (Adelaide) technique (6-strand) or modified Becker method (4-strand). The neurovascular structures were repaired under a microscope. Sixteen patients (47 digits) were treated. According to the criteria of Moiemen and Elliot, the lacerated areas were in zones IA and IB in 7 and 40 digits, respectively. The mean ranges of motion were 149.27 ± 7.78 and 66.43 ± 2.04 degrees according to the Strickland and modified Strickland assessments, respectively. The mean 2-point discrimination was 5.00 ± 0.63 mm. Four patients (group 1) presented with injuries to 2 digits, and 9 (group 2) and 3 (group 3) patients had 3 and 4 injured digits, respectively. The outcomes were satisfactory in terms of the mean range of motion; 2-point discrimination; cold tolerance; visual analog scale pain score; Disabilities of the Arm, Shoulder, and Hand score; and grip strength. There were no differences among the groups. Open multiple-finger injuries involving flexor digitorum profundus rupture with concurrent neurovascular injuries on one or both sides occasionally occur in industrial environments. Fortunately, each digit exhibits a consistent injury type in a particular anatomical location; appropriate repair yields satisfactory outcomes despite the presence of multiple injuries.

An unusual complex suicide involving a chainsaw and a hanging: a case report

BackgroundSuicides or suicidal attempts with power tools such as band or circular saws are rarely encountered in forensic medicine practice; in the forensic literature, only a few cases have been reported. We present the case of a “combined suicide” (self-injurious actions using different methods and involving various bodily sites) carried out with uncommon deadly methods: chainsaw and hanging.Case presentationA 58-year-old Caucasian man was found dead by his wife, hanging from the basement ceiling of the cellar in which he lived. During the investigation of the crime scene, external examination revealed a wide incised wound in the umbilical area showing the muscular and adipose tissues below. On inspection of the garden around the courtyard, the police found a chainsaw with blood spatter on both the blade and the handle. The blade appeared to be compatible with the abdominal injuries.ConclusionsSince the corpse presented this incised wound, it was crucial to establish the manner and the causes of death, as well as to exclude any third-party involvement. In this case, the presence of multiple injuries, potentially lethal, required a differential diagnosis between suicide or homicide. A detailed post-mortem examination, in association with a precise study of the circumstantial data, led the authors to assume that they were dealing with a “complex suicide.”

Examining the impacts of pinnipeds on Atlantic salmon: The effects of river restoration on predator–prey interactions

Abstract Seal populations in the Gulf of Maine have been recovering from historical bounty‐driven declines since they received federal protection in 1972. In the past few decades, their population growth has sparked renewed concerns over conflict between pinniped and fish conservation. In the Penobscot River in Maine, USA, where restoration efforts over the past decade have aimed at restoring diadromous fish runs, seal predation on the endangered Atlantic salmon (Salmo salar) has become a growing concern. Quantitative and qualitative data for individual salmon, as well as the presence of putative seal‐induced injury, have been collected from salmon passing upriver at dams in the Penobscot River since 2012. An analysis of seal‐induced injury rate with demographic data, river herring returns, estuary fish biomass estimates, and timing of peak estuary fish biomass revealed that the seal‐induced injury rate declined in the Penobscot River from 2012 to 2019, coincident with increasing river herring returns and estuary fish biomass. Despite a potentially increasing seal population, these results suggest that predator swamping from increasing forage fish may provide protection to salmon against seal predation. The presence of multiple injuries on an individual salmon was also significantly associated with the probability of a salmon having a seal‐induced injury. Lamprey wounds and lacerations on salmon were commonly associated with seal‐induced injury, suggesting a confounding effect of multiple stressors. This assessment illustrates how multi‐species diadromous restoration activities may alter predator–prey interactions in ways that support salmon conservation efforts. As demonstrated in the Penobscot River, a focus on overall ecosystem health and restoration can benefit multiple species that use the river. Insights from this study may help inform future management decisions in other human‐impacted systems where protected predators come into conflict with endangered prey.

ОЦЕНКА ТРАВМЫ ДЛЯ ПРОГНОЗИРОВАНИЯ ВНУТРИБОЛЬНИЧНОЙ СМЕРТНОСТИ И ИСХОДА ТРАВМЫ ПАЦИЕНТА

The present study is a retrospective, descriptive and analytical study that was conducted on 300 patients with multiple trauma, aged 5 to 75 years. Inclusion criteria included the presence of multiple injuries caused by road traffic accidents and other events. The exclusion criterion was injury to only one area of the body. The causes of injury were divided into four categories: 1) injuries from road traffic crashes, 2) injuries caused by falls from a height, 3) injuries caused by assault, and 4) injuries caused by road traffic accidents with pedestrians. The most common cause of hospitalization due to injury in men and women was road traffic injuries, and there was a significant correlation between injury types and gender (p = 0.001). The results showed that 28 injured people (9.3%) died in hospital, with the largest percentage of deaths occurring in the 21 to 33 age group. The results were based on the number of people who died: 7 (25.0%) of them had penetrating injuries, and 21 (75.0%) had blunt injuries. Data analysis showed a significant correlation between mortality and type of injury (p = 0.004). Key words: Key words: trauma, medical assessment, organ damage, patient, trauma outcome, in-hospital mortality

Determinants of mortality and intensive care requirement in pediatric thoracoabdominal injuries.

Thoracoabdominal injuries (TAI) are an important cause of trauma-related morbidity in children. Early and correct intervention is essential to reduce mortality. We aimed to determine factors associated with mortality and the need for intensive care in TAI. The children admitted to the pediatric emergency department of a tertiary care hospital with TAI in a 6-year-period were enrolled. Demographic data; mechanism of injuries; clinical, laboratory and imaging findings; length of hospital and intensive care unit (ICU) stay; invasive procedures and medical treatments; surgical interventions; and survival outcomes were recorded. The median age of the 136 children was 9 (IQR: 5-14) years and 72.8% were male. The vast majority of injuries were caused by blunt trauma (92.7%). Pulmonary contusion, pneumothorax, splenic, and liver injuries were the most common diagnoses. Motor vehicle accidents were seen in more than half of the cases (52.2%). The median length of hospital stay was 5 (IQR: 2-8) days; 21 patients were hospitalized in the ICU (15.4%). The need for intensive care was higher in patients with lower Glasgow Coma Scale (GCS) scores and lower Pediatric Trauma Scores (PTSs), in the presence of multiple injuries, pulmonary contusion, and pneumothorax (p<0.001). Mortality was seen in nine patients, eight of whom had multiple injuries. The mortality rate was higher in patients with pulmonary contusion and pneumothorax (p=0.002 and p=0.003, respectively). The PTS and GCS were found to be lower in patients who died in hospital (p<0.001). Prolongation of coagulation parameters and hyperglycemia was more common in the non-survivor group (p=0.005 and p=0.004, respectively). Although thoracoabdominal trauma is not common in childhood, it is an important part of trauma-associated mortality. Multiple injuries, pulmonary contusion, pneumothorax, lower GCS, and PTSs can be a sign of serious injuries to which physicians must be alert.

Pattern and outcome of penetrating chest injuries at the Emergency Management Center in Erbil City

Background and objective: Trauma to the chest is a life-threatening condition because the chest contains many vital organs such as the heart, multiple blood vessels, and lungs. This study aimed to identify the pattern and outcome of the war-related penetrating chest injuries at the Emergency Management Center, Erbil, during the Islamic State in Iraq and Syria conflict. Methods: This retrospective study involved 154 chest injured victims at the Emergency Management Centre in Erbil City. Data were collected from the Statistics Department of this hospital from June 2014 to July 2017. Results: The mean (SD) age of the victims was 25.75 ± 11.567 years. The majority of the cases were young (61%), male (85.1%), Kurds (72.1%), and injured outside Erbil governorate (40.9%). The leading cause of injury was bullet injury (74.7 %). Provision of the first aid before admission was high (87%). Most victims did not have any other injuries (66.9%). Surgical operations were performed to the majority of victims (93.5%). Most of them did not develop any complications (78.6%), with only 21.4% of the cases had some complications. The development of the complications was significantly associated with the presence of other injuries (68.6% vs. 83.5%, P = 0.034). Conclusion: During the Islamic State in Iraq and Syria related war in Iraq, chest injury by gunshot had increased. The Emergency Management Center provides a suitable medical service that helped in reducing complications and deaths. The development of complications was significantly associated only with the presence of multiple injuries.

Traumatic Dental Injuries in Children: The Controversies of Managing Primary Tooth luxation Injuries

One of the areas that are most contentious in the diagnosis and management of traumatic dental injuries in children are in the approach toward luxation injuries in the primary dentition. Although the majority of injuries to the primary anterior dentition are luxations, there appears to be little definitive evidence in the dental literature for the management of luxation injuries in primary dentition; namely, intrusive luxations and lateral luxations. Some of the controversies centre on whether particular management approaches are likely to increase likelihood of further damage to the permanent successor, whilst others centre on question of whether certain approaches are likely to increase likelihood of pulpal necrosis or periapical inflammation of the injured primary tooth. There is conflicting published evidence over whether intruded or luxated primary teeth are best extracted, positioned, or monitored for spontaneous repositioning. For intrusion injuries, factors considered in the literature include the degree of intrusion, presence of multiple injuries, and orientation. Many approaches to management of primary tooth luxation focus on the degree of injury or occlusal interference, and novel approaches are described. The controversies are described herein.

A retrospective analysis of the relationship between facial injury and mild traumatic brain injury.

The association between facial injury characteristics and mild traumatic brain injury (mTBI) is unclear. The aim of this study was to determine the association between facial injury characteristics and mTBI. A retrospective review utilizing patients' medical records at the Universiti Kebangsaan Malaysia Medical Centre (UKMMC), Kuala Lumpur, Malaysia, was performed. Records of subjects with a history of facial trauma from 1 April 2012 to 31 December 2012 were selected. Various levels and surgical speciality records were reviewed to ascertain the diagnoses of facial injuries and mTBI. A total of 348 medical records with the diagnosis of facial injuries were included. The prevalence of mTBI among these patients was 41.4% (95% CI 36.2-46.6). The majority of the patients with mTBI were in the age group of 18-25 years old. Patients with or without facial lacerations that were located on the lower face had a significant association with mTBI, P=.001, compared to other types of soft tissue injury. In addition, a statistically significant association was observed between facial fractures occurring to the middle face and mTBI, P=.018. Pearson chi-square test also showed statistically significant association between the severity of facial injuries and mTBI, P=.018. Mild traumatic brain injury should be suspected in patients with facial injuries and particularly those with lower face lacerations, midface fractures, moderate to severe facial injury and presence of multiple injuries.

Imaging algorithms and CT protocols in trauma patients: survey of Swiss emergency centers.

To identify imaging algorithms and indications, CT protocols, and radiation doses in polytrauma patients in Swiss trauma centres. An online survey with multiple choice questions and free-text responses was sent to authorized level-I trauma centres in Switzerland. All centres responded and indicated that they have internal standardized imaging algorithms for polytrauma patients. Nine of 12 centres (75%) perform whole-body CT (WBCT) after focused assessment with sonography for trauma (FAST) and conventional radiography; 3/12 (25%) use WBCT for initial imaging. Indications for WBCT were similar across centres being based on trauma mechanisms, vital signs, and presence of multiple injuries. Seven of 12 centres (58%) perform an arterial and venous phase of the abdomen in split-bolus technique. Six of 12 centres (50%) use multiphase protocols of the head (n = 3) and abdomen (n = 4), whereas 6/12 (50%) use single-phase protocols for WBCT. Arm position was on the patient`s body during scanning (3/12, 25%), alongside the body (2/12, 17%), above the head (2/12, 17%), or was changed during scanning (5/12, 42%). Radiation doses showed large variations across centres ranging from 1268-3988mGy*cm (DLP) per WBCT. Imaging algorithms in polytrauma patients are standardized within, but vary across Swiss trauma centres, similar to the individual WBCT protocols, resulting in large variations in associated radiation doses. • Swiss trauma centres have internal standardized imaging algorithms for trauma patients • Whole-body CT is most commonly used for imaging of trauma patients • CT protocols and radiation doses vary greatly across Swiss trauma centres.

Bilateral Facial Paralysis Caused by Bilateral Temporal Bone Fracture: A Case Report and a Literature Review.

Bilateral facial paralysis caused by bilateral temporal bone fracture is a rare clinical entity, with seven cases reported in the literature to date. In this paper, we describe a 40-year-old male patient with bilateral facial paralysis and hearing loss that developed after an occupational accident. On physical examination, House-Brackmann (HB) facial paralysis of grade 6 was observed on the right side and HB grade 5 paralysis on the left. Upon temporal bone computed tomography (CT) examination, a fracture line exhibiting transverse progression was observed in both petrous temporal bones. Our patient underwent transmastoid facial decompression surgery of the right ear. The patient refused a left-side operation. Such patients require extensive monitoring in intensive care units because the presence of multiple injuries means that facial functions are often very difficult to evaluate. Therefore, delays may ensue in both diagnosis and treatment of bilateral facial paralysis.

Fracture Repair Using a Polyaxial Locking Plate System (PAX)

To report outcomes and complications of dog and cat fractures treated with the polyaxial locking plate system (PAX). Case series. Dogs (n = 60) and 2 cats. Medical records (December 2009-March 2011) of dogs and cats with fractures treated with the PAX system were reviewed. Cases with adequate follow-up to document a functional union, had surgery performed by an author, had no prior treatment of the fracture(s), and with complete operative records were included. Signalment, body weight, bone(s) fractured, area of bone fractured, fracture classification, concurrent orthopedic injuries, complications, time to functional union, if minimally invasive plate osteosynthesis (MIPO) techniques were used, plate size, number of plates, bone graft use, and ancillary methods of fixation were recorded. Additionally, fracture segment: plate length, screw, number of plate holes, number of empty screw holes overlying/adjacent to the fractures, number of cortices engaged above/below the fracture was evaluated. Variables were evaluated statistically for effect on complications and functional union. Sixty-two animals were included. Mean time to functional union was 7.1 weeks. Complications occurred in 12 animals (19%) and plate failure occurred in 3 (5%). Statistically significant factors that affected time to functional union were the presence of multiple injuries and age. Those associated with complications were double plates and number of cortices engaged above and below fractures. The PAX system allows for multidirectional screw insertion with an overall complication rate and time to functional union similar to other fracture repair implant systems.

Timing of Definitive Fixation for Comminuted Talar Fractures in Patients with Multiple Injuries: A case report

Comminuted talar fractures are commonly the result of high-energy trauma. In the literature, the timing for treatment of comminuted talar fractures remains controversial, even in the presence of multiple injuries. We present the case of a stable patient with multiple long bone injuries and a comminuted talar fracture, the subsequent management and outcome, and review the current literature for management of comminuted talar fractures.

Indicators of Severity in Chest Trauma

We undertook a review of patients with chest trauma attended between January 1992 and June 2005 in order to establish severity criteria in these cases. During the study period, 1,772 cases (1,346 [76%] males) were treated, with ages ranging from 7 to 98 years (mean, 46.4 years). The Revised Trauma Score (RTS) was calculated and the following variables were also studied as potential indicators of severity: age, extent of the injury, number of rib fractures, presence of lung contusion, hemothorax, cardiorespiratory repercussions, and need for mechanical ventilation. At the time of admission, 84.4% of patients presented only symptoms related to the injury, with no general repercussions, and 66.7% had an RTS of 12. The number of rib fractures was a reliable indicator of severity, as was the presence of multiple injuries, lung contusion, need for mechanical ventilation, and cardiorespiratory repercussions. Neither age nor presence of hemothorax was found to be an indicator of severity. Pleural drainage was performed in 756 cases and was effective in 670 (88.6%). There are a number of indicators of severity in chest trauma, related more closely to the type and repercussions of the trauma than to the age of the patient. There is a high incidence of fluid or gas accumulation in the pleural space, though this can be easily managed by pleural drainage, which constitutes the main therapeutic procedure in chest trauma.

Variation in the Management of Pediatric Splenic Injuries in the United States

This study examines the existence and sources of variation in the management of pediatric splenic injuries among hospitals in the United States and the factors associated with splenectomy. Information on children 15 years of age and younger with a splenic injury diagnosis code was extracted from the Kids' Inpatient Database 2000, a pediatric inpatient database of 2,784 hospitals in 27 states covering 72% of the nation's population for the year 2000. Patient variables included age, sex, race, injury diagnoses, grade of splenic injury, splenic procedure code, and calculated Injury Severity Score. Hospital variables included pediatric status (free-standing, unit and adult), teaching status, annual pediatric splenic trauma volume, and national region. A multivariate logistic regression model was used to predict the factors associated with splenectomy based upon patient and hospital characteristics. In all, 2,191 children with splenic injuries were identified; 253 (12%) underwent splenectomy. The crude rate of splenectomy varied significantly among pediatric hospital types: 3% (11/339) at freestanding children's hospitals, 9% (45/525) at unit hospitals and 15% (197/1327) at adult hospitals (p < 0.001). Risk of splenectomy increased with the grade of splenic injury, patient age, and the presence of multiple injuries. Teaching hospitals and hospitals with higher patient volume were associated with lower risk for splenectomy. There was no relationship between splenectomy and gender, race, or national region. Despite adjustment for the above noted hospital and patient-specific variables, children treated at an adult hospital had 2.8 times the odds, and those treated at a unit pediatric hospital 2.6 times the odds, of undergoing splenectomy as those cared for at a free-standing pediatric hospital (p = 0.003 and 0.013, respectively). Nationally, children cared for at freestanding pediatric hospitals have a significantly lower risk of splenectomy than children treated at either adult hospitals or pediatric hospitals within an adult hospital. This may have implications for education, trauma triage and the establishment of practice guidelines.

Investigating gender differences in outcome following severe traumatic brain injury in a predominantly Asian population

The objective of this study was to investigate if there are possible gender differences in relation to outcome following closed severe traumatic brain injury (TBI) in a predominantly Asian population. A study was conducted using our prospectively maintained TBI database of 672 patients with severe TBI admitted into our neurosurgical intensive care unit. All patients were managed on a standardized protocol in accordance with the Guidelines to the management of severe traumatic brain injury. Glasgow Outcome Score was used to measure the outcome of patients 6 months postinjury. There were 525 males and 147 females, with the latter significantly older than their counterpart. Females had a significantly higher mortality and poorer outcome compared with males. However, this difference was no longer significant when variables (presence of multiple injuries, postresuscitation pupil abnormalities and Glasgow Coma Score) are controlled for. However, both crude and adjusted odd ratios revealed that females aged 60 and below were significantly more likely to have a poorer outcome.

Variation in Treatment of Pediatric Spleen Injury at Trauma Centers Versus Nontrauma Centers: A Call for Dissemination of American Pediatric Surgical Association Benchmarks and Guidelines

American Pediatric Surgical Association consensus guidelines for children with blunt spleen injuries have been defined and validated in children's hospitals, but large administrative data sets indicate that only 10% to 15% of children with blunt spleen injuries are treated at children's hospitals. We sought to identify the frequency and compare the treatment of children with spleen injury in hospitals with and without recognized trauma expertise, with the aim of identifying a meaningful target for dissemination of benchmarks and consensus guidelines. State health departments' administrative data sets from California, Florida, New Jersey, and New York were analyzed for 2000, 2001, and 2002. All children with head injury or other nonspleen abdominal injuries requiring surgery were excluded. Injury Severity Scores were determined by ICDMAP-90. There were 3,232 patients with blunt spleen injury. Trauma centers had a significantly lower rate of operation for both multiply injured patients (15.3% versus 19.3%, p < 0.001) and those with isolated injury (9.2% versus 18.5%, p < 0.0001) when compared with nontrauma centers. The operative rates at both trauma centers and nontrauma centers exceed published American Pediatric Surgical Association benchmarks for all children with spleen injury (5% to 11%) and the subset with isolated spleen injury (0% to 3%). Independent risk factors for splenectomy included ages 15 to 19 years (p < 0.002), spleen injury severity (p < 0.0001), and presence of multiple injuries (p < 0.04). Adjusted odds ratio for risk of splenic operation in all patients with spleen injury was 2.122 (95% CI:1.455- 3.096) when treated at a nontrauma center (p < 0.0001). These multistate discharge data indicate that treatment of children with blunt spleen injury differs significantly when comparing trauma centers and nontrauma centers. Because nearly two-thirds of these children were treated at trauma centers, dissemination of American Pediatric Surgical Association guidelines and benchmarks through state or regional trauma systems may reduce the number of children having operations for splenic injury.

Foot injuries in the polytraumatized patient

Foot injuries in polytraumatized patients are not critical for survival but for the later quality of life. Closed fractures or dislocations of the foot are frequently overlooked or misinterpreted in association with polytrauma, which leads to severe functional impairment in those patients who survive. Repeated clinical examinations and early radiographic examinations are essential in the unconscious patient after resuscitation. Emergent indications for surgery even in the presence of multiple injuries are open injuries, incarcerated soft tissues, manifest compartment syndrome of the foot, and neurovascular injury. The decision on limb salvage or amputation has to be individualized with respect to the patient's overall condition and the severity of local trauma to the foot. The "life before limb" principle has to be respected. Emergent reduction of fracture dislocations of the talus, calcaneus, Chopart's and Lisfranc's joints via direct approaches and temporary transfixation with K-wires should be attempted in a first step whenever possible. Additional external fixation facilitates wound care and prevents soft tissue contractions until definite internal fixation becomes feasible. Early soft tissue coverage is always sought in order to avoid infection.

Utilidad de las mallas reabsorbibles en los traumatismos esplénicos

The spleen is not an essential organ for survival but given its important role in immunologic functions its preservation is justified.To analyze our experience with absorbable meshes applied to treat splenic injuries.We performed an ambispective study. From July 1999 to February 2004, 30 patients were treated for traumatic splenic injuries. Ultrasonography and/or spiral computed tomography scanning was carried out for the initial screening evaluation and grading of splenic injuries. The New Injury Severity Score (NISS) was calculated to quantify the severity of trauma. Operative splenic preservation was performed according to established selection criteria. Splenorrhaphy with prosthetic material was accomplished by means of a bag of polyglycolic acid mesh measuring 18 cm yen 23 cm (Dexon mesh) that was hand tailored and wrapped around the entire surface of the spleen.Thirty patients with splenic traumatic injuries were treated. The mean age was 36.2 +/- 16.6 years. Twenty-three patients (76.6%) required splenectomy, nonoperative management was achieved in 1 patient (3.3%), and splenorrhaphy with prosthetic material was carried out in 6 patients (20%). Grade III injuries were present in 13 patients (43.3%), grade IV in 13 patients (43.3%), and grade V in 4 patients (13.3%). The mean NISS was 18.9 +/- 9.1. No significant differences were detected between the two groups (splenectomy or mesh splenorrhaphy) in NISS (p=.53) or grade of splenic injuries (p=.69). Morbidity was related to the presence of multiple injuries (p=.002) and was greater in the group with mesh splenorrhaphy (p=.002); however, there were no septic complications in this group. A positive correlation was observed between the length of hospital stay and NISS (p=.01). The length of hospital stay was also significantly associated with the presence of multiple injuries (p=.005) and with morbidity (p=.0002), but was not associated with the type of surgery carried out (p=.17). No complications were observed during follow-up (median of 28 months) in patients who underwent splenic salvage procedures.Mesh splenorrhaphy is a suitable therapeutic option for patients with severe trauma, grade IV splenic injuries, or delayed rupture of the spleen. Both morbidity and length of hospital stay were associated with the presence of multiple injuries rather than with the type of surgery carried out. The safety, effectiveness and absence of septic complications related to the use of prosthetic material in splenic trauma salvage surgery were notable.

Délai diagnostique dans les lésions traumatiques du rachis cervical inférieur

Purpose of the study According to data in the literature, traumatic injury of the inferior cervical spine is not recognized in 4.5 to 33% of victims. The purpose of our study was to evaluate the rate of delayed diagnosis, search for causes, and propose a diagnostic approach. Material and methods This prospective study included 284 patients recruited by eleven referral centers between November 1999 and March 2001. Each participating center completed a data chart and classified lesions. Exclusion criteria were whiplash without neurological disorder and without imaging anomaly, spinal ankylosis, and trauma more than three weeks before the first examination. Results Among the 284 patients included, 240 had a unique lesion of the inferior cervical spine, 44 had multiple injuries. In all, 338 spinal lesions were recorded. There were 35 patients with multiple trauma injuries and 95 patients with spinal cord injuries. Time to diagnosis was less than 24 hours for 211 patients (74%), one day to one week for 38 patients (14%), and more than one week for 35 patients (12%). Defective management was noted in 13% of the cases. Late diagnosis was considered to have had a prejudicial effect in nine patients (3%). There was no correlation between time to diagnosis and type of lesion, level of lesion, or presence of multiple injuries. Discussion Late diagnosis of inferior cervical spine injury can be an inevitable result of the context. This is particularly true for patients with multiple injuries or patients with purely discal or ligament injuries whose first manifestations occur late after the trauma. Beyond these specific situations, there is no logical explanation for late diagnosis other than insufficient diagnostic management. Spinal injury should always be suspected in trauma victims and the initial neurological status must be noted. If the subject is conscious, plain x-rays should be obtained in the event of pain in the cervical spine. A computed tomography is the exploration of choice. Dynamic views should be performed in all cases to search for pure ligament injury. The correct time for such explorations can only be determined on an individual basis. If the patient is unconscious, standard procedure includes x-ray of the cervical spine, and computed tomography of the skull-spine junction and the cervico-thoracic spine. Widespread systematic use of spiral and multiple array computed tomography should limit the number of late diagnoses. Conclusion Late diagnosis of inferior cervical spine injury is probably not uncommon. Improved management can be achieved through better medical awareness, better knowledge of cervical spine injuries, and routine imaging in application of the rule of prudence.