Head, facial, and clavicular trauma as a predictor of cervical-spine injury

Janet Williams, Dietrich Jehle, Eric Cottington, Charles Shufflebarger

Research output: Contribution to journalArticle

67 Citations (Scopus)

Abstract

Study hypothesis: The American College of Surgeons teaches that "trauma occurring above the clavicle should raise a high suspicion for a potential cervical spine injury". In this study, we investigated the association of head, facial, and clavicular trauma with cervical-spine and cord injury. Methods: The records of 5,021 consecutive trauma patients admitted to a Level I regional trauma center during a three and one-half year period were reviewed retrospectively. The incidence rates of head, facial, clavicle, cervical spine, and cervical cord injuries were recorded. Glasgow Coma Scores (GCS) were obtained on all patients. Statistical analysis using multiple logistic regression and χ2 analysis were performed to determine the relationship between traumatic injury above the clavicle and cervical spine and cord injury. Results: Head-injured patients had no greater incidence of cervical-spine injury than did non-head-injured patients (4.76% vs 4.37%, P = .52) but were found to have significantly fewer spinal cord injuries (1.5% vs 2.3%, P = .048). There was no difference in incidence of cervical-spine injuries between patients with and those without facial injuries (4.2% vs 4.6%, P = .61). However, there were significantly fewer cord injuries among patients with facial injuries (0.75% vs 2.2%, P = .01). The presence or absence of clavicular fracture was not associated with a significant increase in cervical spine (6.9% vs 4.4%, P = .11) or cervical cord injuries (1.6% vs 2.0%, P = .68). A GCS of less than 14 was associated with a higher incidence of cervical-spine injury than was a GCS of 14 or more in both head-injured (6.7% vs 3.9%, P = .007) and non-head-injured patients (12.2% vs 5.9%, P = .002). There was a greater incidence of cervical cord injury among patients with a GCS of less than 14 than in those with a GCS of 14 or more in both the head-injured (2.2% vs 1.2%, P = .09) and non-head-injured (8.8% vs 2.7%, P < .0001) groups. Conclusion: Trauma to the head, face, and clavicle is not associated with a higher incidence of cervical-spine or cord injury. Physiologic parameters such as the GCS appear to be more accurate predictors of cervical spine or cord injury than mere evidence of trauma occurring above the clavicle.

Original languageEnglish (US)
Pages (from-to)719-722
Number of pages4
JournalAnnals of Emergency Medicine
Volume21
Issue number6
DOIs
StatePublished - 1992
Externally publishedYes

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Spine
Head
Wounds and Injuries
Coma
Clavicle
Incidence
Facial Injuries
Craniocerebral Trauma
Trauma Centers
Spinal Cord Injuries
Logistic Models
Regression Analysis
Cervical Cord

Keywords

  • cervical-spine injury

ASJC Scopus subject areas

  • Emergency Medicine

Cite this

Head, facial, and clavicular trauma as a predictor of cervical-spine injury. / Williams, Janet; Jehle, Dietrich; Cottington, Eric; Shufflebarger, Charles.

In: Annals of Emergency Medicine, Vol. 21, No. 6, 1992, p. 719-722.

Research output: Contribution to journalArticle

Williams, Janet ; Jehle, Dietrich ; Cottington, Eric ; Shufflebarger, Charles. / Head, facial, and clavicular trauma as a predictor of cervical-spine injury. In: Annals of Emergency Medicine. 1992 ; Vol. 21, No. 6. pp. 719-722.
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abstract = "Study hypothesis: The American College of Surgeons teaches that {"}trauma occurring above the clavicle should raise a high suspicion for a potential cervical spine injury{"}. In this study, we investigated the association of head, facial, and clavicular trauma with cervical-spine and cord injury. Methods: The records of 5,021 consecutive trauma patients admitted to a Level I regional trauma center during a three and one-half year period were reviewed retrospectively. The incidence rates of head, facial, clavicle, cervical spine, and cervical cord injuries were recorded. Glasgow Coma Scores (GCS) were obtained on all patients. Statistical analysis using multiple logistic regression and χ2 analysis were performed to determine the relationship between traumatic injury above the clavicle and cervical spine and cord injury. Results: Head-injured patients had no greater incidence of cervical-spine injury than did non-head-injured patients (4.76{\%} vs 4.37{\%}, P = .52) but were found to have significantly fewer spinal cord injuries (1.5{\%} vs 2.3{\%}, P = .048). There was no difference in incidence of cervical-spine injuries between patients with and those without facial injuries (4.2{\%} vs 4.6{\%}, P = .61). However, there were significantly fewer cord injuries among patients with facial injuries (0.75{\%} vs 2.2{\%}, P = .01). The presence or absence of clavicular fracture was not associated with a significant increase in cervical spine (6.9{\%} vs 4.4{\%}, P = .11) or cervical cord injuries (1.6{\%} vs 2.0{\%}, P = .68). A GCS of less than 14 was associated with a higher incidence of cervical-spine injury than was a GCS of 14 or more in both head-injured (6.7{\%} vs 3.9{\%}, P = .007) and non-head-injured patients (12.2{\%} vs 5.9{\%}, P = .002). There was a greater incidence of cervical cord injury among patients with a GCS of less than 14 than in those with a GCS of 14 or more in both the head-injured (2.2{\%} vs 1.2{\%}, P = .09) and non-head-injured (8.8{\%} vs 2.7{\%}, P < .0001) groups. Conclusion: Trauma to the head, face, and clavicle is not associated with a higher incidence of cervical-spine or cord injury. Physiologic parameters such as the GCS appear to be more accurate predictors of cervical spine or cord injury than mere evidence of trauma occurring above the clavicle.",
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N2 - Study hypothesis: The American College of Surgeons teaches that "trauma occurring above the clavicle should raise a high suspicion for a potential cervical spine injury". In this study, we investigated the association of head, facial, and clavicular trauma with cervical-spine and cord injury. Methods: The records of 5,021 consecutive trauma patients admitted to a Level I regional trauma center during a three and one-half year period were reviewed retrospectively. The incidence rates of head, facial, clavicle, cervical spine, and cervical cord injuries were recorded. Glasgow Coma Scores (GCS) were obtained on all patients. Statistical analysis using multiple logistic regression and χ2 analysis were performed to determine the relationship between traumatic injury above the clavicle and cervical spine and cord injury. Results: Head-injured patients had no greater incidence of cervical-spine injury than did non-head-injured patients (4.76% vs 4.37%, P = .52) but were found to have significantly fewer spinal cord injuries (1.5% vs 2.3%, P = .048). There was no difference in incidence of cervical-spine injuries between patients with and those without facial injuries (4.2% vs 4.6%, P = .61). However, there were significantly fewer cord injuries among patients with facial injuries (0.75% vs 2.2%, P = .01). The presence or absence of clavicular fracture was not associated with a significant increase in cervical spine (6.9% vs 4.4%, P = .11) or cervical cord injuries (1.6% vs 2.0%, P = .68). A GCS of less than 14 was associated with a higher incidence of cervical-spine injury than was a GCS of 14 or more in both head-injured (6.7% vs 3.9%, P = .007) and non-head-injured patients (12.2% vs 5.9%, P = .002). There was a greater incidence of cervical cord injury among patients with a GCS of less than 14 than in those with a GCS of 14 or more in both the head-injured (2.2% vs 1.2%, P = .09) and non-head-injured (8.8% vs 2.7%, P < .0001) groups. Conclusion: Trauma to the head, face, and clavicle is not associated with a higher incidence of cervical-spine or cord injury. Physiologic parameters such as the GCS appear to be more accurate predictors of cervical spine or cord injury than mere evidence of trauma occurring above the clavicle.

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