The reliability of prehospital clinical evaluation for potential spinal injury is not affected by the mechanism of injury.

INTRODUCTION: Traditional EMS teaching identifies mechanism of injury as an important predictor of spinal injury. Clinical criteria to select patients for immobilization are being studied in Michigan and have been implemented in Maine. Maine requires automatic immobilization of patients with "a positive mechanism" clearly capable of producing spinal injury. OBJECTIVE: To determine whether mechanism of injury affects the ability of clinical criteria to identify patients with spinal injury. METHODS: In this multicenter prospective cohort study, EMS personnel completed a check-off data sheet for prehospital spine-immobilized patients. Data included mechanism of injury and yes/no determinations of the clinical criteria: altered mental status, neurologic deficit, evidence of intoxication, spinal pain or tenderness, and suspected extremity fracture. Hospital outcome data included confirmation of spinal injury and treatment required. Mechanisms of injury were tabulated and rates of spinal injury for each mechanism were calculated. The patients were divided into three different high-risk and low-risk groups. RESULTS: Data were collected for 6,500 patients. There were 209 (3.2%) patients with spinal injuries identified. There were 1,058 patients with 100 (9.4%) injuries in the first high-risk mechanism group, and 5,423 patients with 109 (2%) injuries in the first low-risk group. Criteria identified 97 of 100 (97%) injuries in the high-risk group and 102 of 109 (94%) in the low-risk group. Two additional data divisions yielded identical results. CONCLUSION: Mechanism of injury does not affect the ability of clinical criteria to predict spinal injury in this population.

Spinal epidural hematoma progressing to Brown-Sequard syndrome: report of a case.

A 51-yr-old woman was transferred to the emergency department with nonspecific interscapular pain and a progressive right-sided hemiparesis. Physical examination and laboratory examination revealed moderate right-sided hemiparesis, with no other focal neurologic deficits. A computed axial tomography scan of the brain was negative. Emergency arteriography revealed bilateral highgrade fibromuscular dysplasia involving the origins of the left and right common carotid arteries. The patient was admitted with the presumptive diagnosis of embolic cerebrovascular accident. Subsequently, the patient developed a left-sided sensory deficit, and magnetic resonance imaging of the cervical spine revealed a C5-T2 epidural hemorrhage. The patient underwent emergent surgical evacuation of the clot and recovered without incident. Spinal epidural hematomas are rare and typically present as cord compressions with or without pain rather than as unilateral hemiplegia.

Gore-Tex (polytetrafluoroethylene) in canine coronary artery bypass.

Because of the occasional need for a prosthesis in coronary artery operations, we investigated the potential use of microporous polytetrofluoroethylene (PTFE) with and without antiplatelet drugs as an aorta-coronary bypass graft in 43 dogs. In 13 animals without antiplatelet drugs, no grafts were patent at 1 month. When antiplatelet drugs were used (25 dogs), the 1 month patency rate increased to 64%. The addition of antibiotic treatment 1 month patency rate to 80%. The 6 month patency rate in dogs treated with antiplatelet drugs, preoperative bowel preparation, and systemic antibiotics was 60%. Our data indicate that microporous PTFE grafts used as coronary artery bypass grafts in dogs can be maintained patent for at least 6 months when the animals are treated with antiplatelet drugs.