Rates Of Spinal Injury Research Articles

Spinal injury rates and specific causation in motor vehicle collisions

Motor vehicle collisions (MVCs) are a leading cause of acute spinal injuries. Chronic spinal pathologies are common in the population. Thus, determining the incidence of different types of spinal injuries due to MVCs and understanding biomechanical mechanism of these injuries is important for distinguishing acute injuries from chronic degenerative disease. This paper describes methods for determining causation of spinal pathologies from MVCs based on rates of injury and analysis of the biomechanics require to produce these injuries. Rates of spinal injuries in MVCs were determined using two distinct methodologies and interpreted using a focused review of salient biomechanical literature. One methodology used incidence data from the Nationwide Emergency Department Sample and exposure data from the Crash Report Sample System supplemented with a telephone survey to estimate total national exposure to MVC. The other used incidence and exposure data from the Crash Investigation Sampling System. Linking the clinical and biomechanical findings yielded several conclusions. First, spinal injuries caused by an MVC are relatively rare (511 injured occupants per 10,000 exposed to an MVC), which is consistent with the biomechanical forces required to generate injury. Second, spinal injury rates increase as impact severity increases, and fractures are more common in higher-severity exposures. Third, the rate of sprain/strain in the cervical spine is greater than in the lumbar spine. Fourth, spinal disc injuries are extremely rare in MVCs (0.01 occupants per 10,000 exposed) and typically occur with concomitant trauma, which is consistent with the biomechanical findings 1) that disc herniations are fatigue injuries caused by cyclic loading, 2) the disc is almost never the first structure to be injured in impact loading unless it is highly flexed and compressed, and 3) that most crashes involve predominantly tensile loading in the spine, which does not cause isolated disc herniations. These biomechanical findings illustrate that determining causation when an MVC occupant presents with disc pathology must be based on the specifics of that presentation and the crash circumstances and, more broadly, that any causation determination must be informed by competent biomechanical analysis.

Spinal clearance practices at a regional Australian hospital: A window to major trauma management performance outside metropolitan trauma centres

Background: Prevention of secondary spinal injury via spinal protection measures is a standard component of trauma management, and a high-quality spinal clearance process is imperative in achieving this aim. To evaluate the current practice with a view to achieving best practice, we sought to examine the spinal clearance process and outcomes at a regional Australian referral hospital, which services a large geographical catchment area. Methods: A retrospective review of medical records of all patients with major trauma who presented to an Australian regional hospital during 2014 was conducted. The primary outcome measure was missed or delayed diagnosis of spinal injury. Secondary outcome measures included compliance with internationally accepted spinal clearance process measures, timing and choice of appropriate imaging modalities, rates of spinal injury and documentation of spinal clearance. Results: Of the 112 patients with major trauma who met the study eligibility criteria and were discharged from hospital during the study period from 1 January to 31 December 2014, 11 spinal injuries were missed or delayed in diagnosis. The injuries occurred in 3.6% of patients and all were thoracolumbar spine (TLS) injuries. The predominant reasons for missed or delayed diagnosis were reduced sensitivity of plain X-ray compared with computed tomography for spinal injury screening and incomplete full spinal imaging to detect non-contiguous fractures. Conclusion: Evidence-based clinical decision rules are imperative in ascertaining the need for imaging in the TLS and would be enhanced by an internationally recognised definition of clinical significance based on injury morphology rather than clinician management decision alone. In addition, regional hospitals may have limited capacity to achieve spinal clearance, and other trauma quality assurance standards commensurate with national and international benchmarks without the valuable performance feedback provided by state trauma registries, as is currently the case in Queensland.

CT Alone for Cervical Spine Clearance in Intoxicated Patients

Because computed tomography (CT) is considered insensitive for ligamentous injuries, many intoxicated patients with concern for cervical spine injury are kept in a cervical collar or undergo magnetic resonance imaging (MRI), even after a normal CT scan. Growing evidence questions whether truly unstable injuries are missed by modern CT. These researchers prospectively assessed rates of spinal injuries missed by modern cervical spine CT scans in 1668 …

Trends in All-Terrain Vehicle-related Spinal Injuries in Children and Adolescents

Despite the significant morbidity and mortality associated with all-terrain vehicle (ATV) use in children, their use continues to increase dramatically. To determine the frequency and impact of spinal fractures in children and adolescents injured in ATV accidents, we reviewed all 4 of the available Kids' Inpatient Databases. The Kids' Inpatient Databases (http://www.ahrq.gov/data/hcup/hcupkid.htm) from 1997, 2000, 2003, and 2006 were reviewed using e-codes for children (age less than 18 y) injured in ATV accidents. From the data on ATV accidents, children who sustained spinal injuries were identified by ICD-9 codes. Statistical analysis was done using SAS Windows. An estimated 4,483 children were admitted because of ATV-related accidents in 2006. Spinal injury occurred in 7.4% of patients. The most common level of fracture was thoracic (39%), followed by lumbar (29%) and cervical (16%). Pelvic fractures were the most common associated fractures, accounting for 44% of all musculoskeletal injuries, followed by forearm/wrist fractures (15%) and femoral fractures (9%). Although fewer girls were injured in ATV accidents than boys, the risk of spinal injury was higher in girls than boys (10.1% vs. 6.7%, P < 0.005), and children with spinal injuries were older than those without (14.7 y vs. 12.7 y, P < 0.001). Despite educational and legislative efforts, children account for a disproportionate percentage of morbidity and mortality from ATV-related accidents. The injury rate for children from ATV accidents has increased 240% since 1997, whereas the spinal injury rate has increased 476% over the same time frame. The risk of spinal injury in ATV-related accidents is higher for girls than for boys and for older children. Multiple injuries are frequent in children involved in ATV accidents and may be related to the high-energy nature of ATV accidents. It is important to have a high index of suspicion for multiple injuries, not only within the spine, but in other organ systems as well.

Comminuted fracture of the thoracic spine

Road deaths fell initially after the introduction of the penalty points but despite this, the rate of spinal injuries remained unchanged. We report a patient with a dramatic spinal injury, though without neurological deficit. We discuss the classification, management and economic impact of these injuries. We describe the management of a patient with a comminuted thoracic spinal fracture without neurological injury. We conducted a literature review with regard to the availability of literature of the management of these injuries. This 17-year-old female was managed surgically and had a good functional outcome. There is no clear consensus in the published literature on the management of these injuries. Comminuted thoracic spinal factures are potentially devastating. Such a patient presents challenges in determining the appropriate treatment.

Spinal injuries in skiers and snowboarders.

Spinal injuries are among the most devastating injuries associated with recreational sports. Snowboarding spinal injury patterns have not been described. During two seasons (1994 to 1995 and 1995 to 1996), 34 skiers and 22 snowboarders suffered serious spinal injuries (fracture or neurologic deficit or both) at two ski areas in British Columbia, Canada. Ski patrol records, the Provincial Trauma Database, and hospital records were reviewed. Injury rates were based on computerized lift-ticket data and a population estimate of 15% snowboarders (ski patrol observation). The incidence of spinal injury among skiers was 0.01 per 1000 skier-days, and among snowboarders was 0.04 per 1000 snowboarder-days. Mean age was 34.5 years for skiers and 22.4 years for snowboarders. Seventy percent of the skiers were men, whereas all of the snowboarders were men. Jumping (intentional jump > 2 meters) was the cause of injury in 20% of skiers and 77% of snowboarders. Neither age nor sex accounted for any significant portion of this difference. The rate of spinal injuries among snowboarders is fourfold that among skiers. Although jumping is the primary cause of injury, it is an intrinsic element of snowboarding. Until research defines effective injury-prevention strategies, knowledge of the risk of snowboarding should be disseminated and techniques for safe jumping should be taught.

AC Electrofishing Injury of Large Brown Trout in Low-Conductivity Streams

Fifty-seven large brown trout Salmo trutta (mean total length, 407 mm; range, 264–647 mm) were collected by backpack AC electrofishing from seven low-conductivity (12–60 μS/cm) Tennessee streams and examined by X ray and necropsy for injuries. No fish died during sampling or before processing in the field. Overall, 34 fish (60%) had hemorrhagic injuries and 20 of these (35%) had class−1 or −2 spinal compressions or subluxations. Eighteen of the spinal injuries (90%) were accompanied by hemorrhage of adjacent musculature. Injury rates were lower for fish shorter than 305 mm (N = 5, 1 injured) and longer than 500 mm (N = 6, 1 injured) when compared with fish 305–500 mm (N = 46, 32 injured). Temporary skin discolorations (sometimes referred to as “brands”) were observed on 24 fish (42%), 19 of which were injured. These discolorations were between the dorsal and caudal fins (where spinal injuries typically occurred) and were significantly related to the incidence and severity of hemorrhage (P = 0.004) and spinal injury (P = 0.006). The overall spinal injury rate (35%) was within the range reported for large brown trout collected with DC electrofishing gear in streams of higher conductivity (8–84%). Twenty-three percent of the fish we examined had injuries of at least moderate severity (class-2 spinal injuries and class−2 or −3 hemorrhages), but because only a small portion of any stream is actually sampled, we concluded there is limited potential for AC electrofishing injuries incurred by large brown trout in low-conductivity streams to cause population level impacts.

Spinal Injury Rates in Three Wild Trout Populations in Colorado after Eight Years of Backpack Electrofishing

We examined long-term effects of annual intensive backpack electrofishing on rates of spinal injury and population abundance of three salmonid and one catostomid species in three small northern Colorado streams and compared rates of externally evident injuries to actual injuries determined by X ray. After 6–8 years of annual three-pass removal electrofishing, injury rates for brook trout Salvelinus fontinalis in treatment sections of two streams averaged 10.4% and 12.3%, but were 0% in previously unshocked controls. In a third stream containing all species in sympatry, longnose suckers Catostomus catostomus sustained the highest average injury rates (9.6%), followed by brown trout Salmo trutta (6.9%), rainbow trout Oncorhynchus mykiss (4.0%), and brook trout (3.5%). These rates were based on external evaluation and probably greatly underestimated actual rates of healed injuries because 44% of X-rayed fish with no externally evident spinal injury showed previous injury. Despite the high incidence of spinal injury, abundance of all salmonid species remained stable or increased in the three streams during the 8-year study, which indicated that there were no detectable adverse population effects of repeated electrofishing. In contrast, abundance of longnose sucker declined significantly. Our results indicate that spinal injuries accumulated over time and that species probably differ in susceptibility to the deleterious effects of electrofishing.