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1.
World Neurosurg ; 130: e368-e374, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31229750

RESUMO

OBJECTIVE: 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. METHODS: 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. RESULTS: 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. CONCLUSION: The AOSpine Subaxial Cervical Spine Injury Classification System successfully associated injury morphology with IMLL along with admission and long-term neurologic function and recovery.


Assuntos
Vértebras Cervicais/lesões , Traumatismos da Coluna Vertebral/classificação , Traumatismos da Coluna Vertebral/diagnóstico , Vértebras Cervicais/patologia , Feminino , Hospitalização , Humanos , Escala de Gravidade do Ferimento , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fraturas da Coluna Vertebral/classificação , Fraturas da Coluna Vertebral/diagnóstico , Fraturas da Coluna Vertebral/epidemiologia , Fraturas da Coluna Vertebral/patologia , Traumatismos da Coluna Vertebral/epidemiologia , Traumatismos da Coluna Vertebral/patologia
2.
Australas Emerg Care ; 22(2): 69-75, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31053486

RESUMO

BACKGROUND: In the Emergency Department cervical spine immobilisation precautions are frequently used. There is controversy in regard to the balance of risks and benefits of routine immobilisation in conscious patients. METHODS: A prospective multi-methods evaluation in a tertiary trauma referral centre. The objectives were to investigate current practices and rate of concordance with established international guidelines. A provider survey focused on current knowledge, skills and attitudes and was disseminated to nurses, doctors and paramedics treating trauma patients. Additionally, clinical data were collected on a cohort of immobilised trauma patients. Demographic data were analysed using SPSS and content analysis was completed by manifest coding. RESULTS: The response rate to the survey was 85.2%. Interdisciplinary providers included nurses (n=46), doctors (n=68) and paramedics (n=41). Content analysis revealed a range of themes for improving care. Themes identified included improved application of guidelines, tailored use of equipment in low-risk patients, improved access to radiology results, and staff education. The series of five case vignettes provided to participants revealed a high level of variance in intended approaches to immobilisation. In the cohort of trauma patients (n=54), the median age was 54 years and the most common mechanism of injury was falls (40.7%). Median time spent with immobilisation was 325min. Adherence to a recognised decision tool was 35/54 (64.8%). Precautions were initiated by paramedics in 42/54 (77.8%). CONCLUSIONS: Despite widespread dissemination of guidelines, observed approaches to patient immobilisation appear to be highly variable in this trauma centre. Reducing variation for low-risk patients is likely to improve the patient journey and minimise the risk of prolonged immobilisation. Further assessment of the causes of variation could define goals for targeted translational change.


Assuntos
Vértebras Cervicais/lesões , Imobilização/normas , Ferimentos e Lesões/complicações , Adulto , Idoso , Vértebras Cervicais/fisiopatologia , Serviço Hospitalar de Emergência/organização & administração , Serviço Hospitalar de Emergência/estatística & dados numéricos , Feminino , Pessoal de Saúde/psicologia , Pessoal de Saúde/estatística & dados numéricos , Humanos , Imobilização/estatística & dados numéricos , Escala de Gravidade do Ferimento , Masculino , Pessoa de Meia-Idade , New South Wales , Estudos Prospectivos , Traumatismos da Coluna Vertebral/diagnóstico , Traumatismos da Coluna Vertebral/fisiopatologia , Inquéritos e Questionários , Centros de Atenção Terciária/organização & administração , Centros de Atenção Terciária/estatística & dados numéricos , Triagem/normas , Triagem/estatística & dados numéricos , Ferimentos e Lesões/fisiopatologia
3.
Am Surg ; 85(5): 549-555, 2019 May 01.
Artigo em Inglês | MEDLINE | ID: mdl-31126370

RESUMO

Survivors of near-hangings suffer anoxic brain injuries, but it remains uncertain whether the incidence of associated injuries warrants extensive workup or trauma activation. An 11-year retrospective review was conducted on adult patients with a hanging mechanism who underwent trauma workup and management. The majority of patients (n = 98) were white (88.8%) males (75.5%) with an average age of 30 ± 12.3 years. Two-hundred fifty-four CT and magnetic resonance scans were performed and eight injuries were uncovered: three thyroid cartilage/hyoid fractures; three vertebral injuries; and two cervical vascular injuries. Anoxic brain injury was diagnosed clinically in 35 patients (35.7%) and was present in all 19 patients (19.4%) who died. Only one patient had intra-abdominal injury requiring surgical intervention. Injuries were more likely in patients with abnormal Glasgow Coma Scale (GCS) versus normal GCS (55% vs 10.5%, respectively). Patients who present after near-hanging have a low incidence of associated injuries. Workup can be restricted to patients with abnormal GCS scores and for specific signs and symptoms or high-risk energy mechanisms. The trauma team can be activated for signs of trauma.


Assuntos
Lesões Encefálicas/epidemiologia , Vértebras Cervicais/lesões , Hipóxia Encefálica/epidemiologia , Lesões do Pescoço/epidemiologia , Traumatismos da Coluna Vertebral/epidemiologia , Tentativa de Suicídio , Adolescente , Adulto , Lesões Encefálicas/diagnóstico , Lesões Encefálicas/terapia , Feminino , Humanos , Hipóxia Encefálica/diagnóstico , Hipóxia Encefálica/terapia , Masculino , Lesões do Pescoço/diagnóstico , Lesões do Pescoço/terapia , Estudos Retrospectivos , Traumatismos da Coluna Vertebral/diagnóstico , Traumatismos da Coluna Vertebral/terapia , Adulto Jovem
4.
J Pediatr Surg ; 54(11): 2353-2357, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-30928154

RESUMO

BACKGROUND: Cervical spine injuries (CSI) are a major concern in young pediatric trauma patients. The consequences of missed injuries and difficulties in injury clearance for non-verbal patients have led to a tendency to image young children. Imaging, particularly computed tomography (CT) scans, presents risks including radiation-induced carcinogenesis. In this study we leverage machine learning methods to develop highly accurate clinical decision rules to predict pediatric CSI. METHODS: The PEDSPINE I registry was used to investigate CSI in blunt trauma patients under the age of three. Predictive models were built using Optimal Classification Trees, a novel machine learning approach offering high accuracy and interpretability, as well as other widely used machine learning methods. RESULTS: The final Optimal Classification Trees model predicts injury based on overall Glasgow Coma Score (GCS) and patient age. This model has a sensitivity of 93.3% and specificity of 82.3% on the full dataset. It has comparable or superior performance to other machine learning methods as well as existing clinical decision rules. CONCLUSIONS: This study developed a decision rule that achieves high injury identification while reducing unnecessary imaging. It demonstrates the value of machine learning in improving clinical decision protocols for pediatric trauma. TYPE OF STUDY: Retrospective Prognosis Study. LEVEL OF EVIDENCE: II.


Assuntos
Vértebras Cervicais/lesões , Aprendizado de Máquina , Traumatismos da Coluna Vertebral/diagnóstico , Fatores Etários , Algoritmos , Pré-Escolar , Feminino , Escala de Coma de Glasgow , Humanos , Lactente , Masculino , Sistema de Registros , Estudos Retrospectivos , Sensibilidade e Especificidade
5.
Ulus Travma Acil Cerrahi Derg ; 25(2): 167-171, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30892669

RESUMO

BACKGROUND: Injuries caused by motorcycle accidents have been reported in several studies with an examination from a general trauma point of view. However, to our knowledge, there is no detailed study specific to central nervous system injuries. This research was focused on central nervous system injuries associated with motorcycle accidents. METHODS: The medical records of 540 patients who were admitted to the emergency department between 2008 and 2016 as the result of a motorcycle accident were retrospectively evaluated. Data were collected from electronic medical records, follow-up forms, and radiological images. Information on patient age, gender, type and site of injury, helmet use, alcohol level, Glasgow Coma Scale score on admission, length of stay in the intensive care unit and hospital, neurological status on discharge, and follow-up was collected and analyzed. RESULTS: A total of 486 of 540 patients (90%) were male, 54 (10%) were female, and the mean age was 31+-18 years (range: 2-85 years, median: 25 years). Cranial injuries were detected in 320 cases (59%). The distribution of cranial injuries was: epidural hemorrhage (12.6%), subdural hemorrhage (15.2%), depressed fracture (10.4%), linear fracture (23%), skull base fracture (5.5%), diffuse axonal injury (9.3%), subarachnoid hemorrhage (25.2%), intracerebral hemorrhage (13.5%), and contusion (26.3%). Spinal fractures were detected in 52 cases (9.6%). Twenty-two (4.07%) of the spinal fractures were observed in the cervical region, 10 (1.85%) in the thoracic region, and 20 (3.7%) in the lumbar region. The mean length of stay in the hospital was 8.2+-4 days and 7 days in the intensive care unit. Sixty-eight patients (12.6%) died. Traumatic cranial entities other than linear fracture were associated with an elevated level of mortality. A Glasgow Coma Scale score of 6 or less was associated with significant mortality (68%). CONCLUSION: A detailed report of motorcycle accident-associated central nervous system injuries is provided. The use of protective equipment, such as helmets, significantly reduced the rate of cerebral injury and death.


Assuntos
Acidentes de Trânsito/estatística & dados numéricos , Traumatismos Craniocerebrais , Motocicletas , Traumatismos da Coluna Vertebral , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , Traumatismos Craniocerebrais/diagnóstico , Traumatismos Craniocerebrais/epidemiologia , Traumatismos Craniocerebrais/terapia , Feminino , Hospitalização , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Traumatismos da Coluna Vertebral/diagnóstico , Traumatismos da Coluna Vertebral/epidemiologia , Traumatismos da Coluna Vertebral/cirurgia , Adulto Jovem
6.
Korean J Radiol ; 20(4): 641-648, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30887746

RESUMO

OBJECTIVE: The purpose of this study was to investigate whether three-dimensional (3D) magnetic resonance imaging could improve diagnostic accuracy for suspected posterior ligamentous complex (PLC) disruption. MATERIALS AND METHODS: We used 20 freshly harvested goat spine samples with 60 segments and intact surrounding soft tissue. The animals were aged 1-1.5 years and consisted of 8 males and 12 females, which were sexually mature but had not reached adult weights. We created a paraspinal contusion model by percutaneously injecting 10 mL saline into each side of the interspinous ligament (ISL). All segments underwent T2-weighted sagittal and coronal short inversion time inversion recovery (STIR) scans as well as coronal and sagittal 3D proton density-weighted spectrally selective inversion recovery (3D-PDW-SPIR) scans acquired at 1.5T. Following scanning, some ISLs were cut and then the segments were re-scanned using the same magnetic resonance (MR) techniques. Two radiologists independently assessed the MR images, and the reliability of ISL tear interpretation was assessed using the kappa coefficient. The chi-square test was used to compare the diagnostic accuracy of images obtained using the different MR techniques. RESULTS: The interobserver reliability for detecting ISL disruption was high for all imaging techniques (0.776-0.949). The sensitivity, specificity, and diagnostic accuracy of the coronal 3D-PDW-SPIR technique for detecting ISL tears were 100, 96.9, and 97.9%, respectively, which were significantly higher than those of the sagittal STIR (p = 0.000), coronal STIR (p = 0.000), and sagittal 3D-PDW-SPIR (p = 0.001) techniques. CONCLUSION: Compared to other MR methods, coronal 3D-PDW-SPIR provides a more accurate diagnosis of ISL disruption. Adding coronal 3D-PDW-SPIR to a routine MR protocol may help to identify PLC disruptions in cases with nearby contusion.


Assuntos
Imagem por Ressonância Magnética/métodos , Traumatismos da Coluna Vertebral/diagnóstico , Animais , Modelos Animais de Doenças , Feminino , Cabras , Imagem Tridimensional , Masculino , Reprodutibilidade dos Testes , Sensibilidade e Especificidade , Traumatismos da Coluna Vertebral/diagnóstico por imagem , Coluna Vertebral/diagnóstico por imagem
7.
J Bone Joint Surg Am ; 101(1): e1, 2019 Jan 02.
Artigo em Inglês | MEDLINE | ID: mdl-30601421
8.
Neurosurgery ; 84(1): 2-6, 2019 01 01.
Artigo em Inglês | MEDLINE | ID: mdl-30202985

RESUMO

BACKGROUND: The thoracic and lumbar ("thoracolumbar") spine are the most commonly injured region of the spine in blunt trauma. Trauma of the thoracolumbar spine is frequently associated with spinal cord injury and other visceral and bony injuries. Prolonged pain and disability after thoracolumbar trauma present a significant burden on patients and society. OBJECTIVE: To formulate evidence-based clinical practice recommendations for the care of patients with injuries to the thoracolumbar spine. METHODS: A systematic review of the literature was performed using the National Library of Medicine PubMed database and the Cochrane Library for studies relevant to thoracolumbar spinal injuries based on specific clinically oriented questions. Relevant publications were selected for review. RESULTS: For all of the questions posed, the literature search yielded a total of 6561 abstracts. The task force selected 804 articles for full text review, and 78 were selected for inclusion in this overall systematic review. CONCLUSION: The available evidence for the evaluation and treatment of patients with thoracolumbar spine injuries demonstrates considerable heterogeneity and highly variable degrees of quality. However, the workgroup was able to formulate a number of key recommendations to guide clinical practice. Further research is needed to counter the relative paucity of evidence that specifically pertains to patients with only thoracolumbar spine injuries. The full version of the guideline can be reviewed at: https://www.cns.org/guideline-chapters/congress-neurological-surgeons-systematic-review-evidence-based-guidelines/chapter_1.


Assuntos
Vértebras Lombares/lesões , Vértebras Lombares/cirurgia , Procedimentos Neurocirúrgicos/métodos , Procedimentos Neurocirúrgicos/normas , Fraturas da Coluna Vertebral/diagnóstico , Fraturas da Coluna Vertebral/cirurgia , Traumatismos da Coluna Vertebral/diagnóstico , Traumatismos da Coluna Vertebral/cirurgia , Vértebras Torácicas/lesões , Vértebras Torácicas/cirurgia , Medicina Baseada em Evidências , Humanos
9.
Neurosurgery ; 84(1): E32-E35, 2019 01 01.
Artigo em Inglês | MEDLINE | ID: mdl-30203084

RESUMO

QUESTION 1: Which neurological assessment tools have demonstrated internal reliability and validity in the management of patients with thoracic and lumbar fractures (ie, do these instruments provide consistent information between different care providers)? RECOMMENDATION 1: Numerous neurologic assessment scales (Functional Independence Measure, Sunnybrook Cord Injury Scale and Frankel Scale for Spinal Cord Injury) have demonstrated internal reliability and validity in the management of patients with thoracic and lumbar fractures. Unfortunately, other contemporaneous measurement scales (ie, American Spinal Cord Injury Association Impairment Scale) have not been specifically studied in patients with thoracic and lumbar fractures. Strength of Recommendation: Grade C. QUESTION 2: Are there any clinical findings (eg, presenting neurological grade/function) in patients with thoracic and lumbar fractures that can assist in predicting clinical outcomes? RECOMMENDATION 2: Entry American Spinal Injury Association Impairment Scale grade, sacral sensation, ankle spasticity, urethral and rectal sphincter function, and AbH motor function can be used to predict neurological function and outcome in patients with thoracic and lumbar fractures (Table I https://www.cns.org/guideline-chapters/congress-neurological-surgeons-systematic-review-evidence-based-guidelines/chapter_4_table1). Strength of Recommendation: Grade B The full version of the guideline can be reviewed at: https://www.cns.org/guideline-chapters/congress-neurological-surgeons-systematic-review-evidence-based-guidelines/chapter_4.


Assuntos
Vértebras Lombares/lesões , Exame Neurológico , Neurocirurgia/normas , Traumatismos da Coluna Vertebral/diagnóstico , Vértebras Torácicas/lesões , Medicina Baseada em Evidências , Guias como Assunto , Humanos , Traumatismos da Medula Espinal/diagnóstico , Traumatismos da Medula Espinal/fisiopatologia , Traumatismos da Medula Espinal/cirurgia , Traumatismos da Coluna Vertebral/fisiopatologia , Traumatismos da Coluna Vertebral/cirurgia
11.
J Pediatr Orthop ; 39(2): 85-89, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-27662382

RESUMO

BACKGROUND: Although rare, spinal injuries associated with abuse can have potentially devastating implications in the pediatric population. We analyzed the association of pediatric spine injury in abused children and determined the anatomic level of the spine affected, while also focusing on patient demographics, length of stay, and total hospital charges compared with spine patients without a diagnosis of abuse. METHODS: A retrospective review of the Kids' Inpatient Database was conducted from 2000 to 2012 to identify pediatric patients (below 18 y) who sustained vertebral column fractures or spinal cord injuries. Patients with a documented diagnosis of abuse were identified using ICD-9-CM diagnosis codes. Our statistical models consisted of multivariate linear regressions that were adjusted for age, race, and sex. RESULTS: There were 22,192 pediatric patients with a diagnosis of spinal cord or vertebral column injury during the study period, 116 (0.5%) of whom also had a documented diagnosis of abuse. The most common type of abuse was physical (75.9%). Compared with nonabused patients, abused patients were more likely to be below 2 years of age (OR=133.4; 95% CI, 89.5-198.8), female (OR=1.67; 95% CI, 1.16-2.41), and nonwhite (black: OR=3.86; 95% CI, 2.31-6.45; Hispanic: OR=2.86; 95% CI, 1.68-4.86; other: OR=2.33; 95% CI, 1.11-4.86). Abused patients also presented with an increased risk of thoracic (OR=2.57; 95% CI, 1.67-3.97) and lumbar (OR=1.67; 95% CI, 1.03-2.72) vertebral column fractures and had a multivariate-adjusted mean length of stay that was 62.2% longer (P<0.001) and mean total charges that were 52.9% higher (P<0.001) compared with nonabused patients. Furthermore, 19.7% of all pediatric spine patients under 2 years of age admitted during the study period belonged to the abused cohort. CONCLUSIONS: Spine injuries are rare but can be found in the pediatric population. With an additional documented diagnosis of abuse, these injuries affect younger patients in the thoracolumbar region of the spine, and lead to longer lengths of stay and higher hospital costs when compared with nonabused patients. Because of these findings, physicians should maintain a higher level of suspicion of abuse in patients with spine injuries, especially patients under 2 years of age. LEVEL OF EVIDENCE: Level III evidence-a case-control study.


Assuntos
Maus-Tratos Infantis/estatística & dados numéricos , Pacientes Internados/estatística & dados numéricos , Traumatismos da Coluna Vertebral/etiologia , Pré-Escolar , Bases de Dados Factuais , Feminino , Seguimentos , Humanos , Incidência , Masculino , Estudos Retrospectivos , Traumatismos da Coluna Vertebral/diagnóstico , Traumatismos da Coluna Vertebral/epidemiologia , Índices de Gravidade do Trauma , Estados Unidos/epidemiologia
12.
Ann Vasc Surg ; 56: 24-28, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30500652

RESUMO

BACKGROUND: The aim of this study is to describe the timing of venous thromboembolism (VTE) diagnosis in patients with cerebral or spinal trauma and stroke and describe the relationships between VTE prophylaxis and timing of VTE diagnosis at a community hospital. METHODS: Retrospective cohort observational study over a span of 10 years from 2006 to 2016 was conducted. RESULTS: Lower extremity ultrasound surveillance identified 138 patients who developed VTE during their hospital stay (mean age 62 years, 61.6% males). Mechanical prophylaxis was used in 79.7% and pharmacologic prophylaxis in 78.3% of patients. The average time of admission to administration of mechanical prophylaxis was 1.92 and 7.7 days for pharmacologic prophylaxis. In patients who received pharmacologic prophylaxis within 2 days, 51.5% of all VTE events occurred during the first week, 73.5% by the second week, and 91.2% by the third week of the hospital stay. In patients who started pharmacologic prophylaxis after 2 days in the hospital, 85% of all VTE events occurred within the first week and 90% within 10 days of the hospital stay (P < 0.001). The timing of initiation of mechanical prophylaxis did not influence the timing of VTE events. CONCLUSIONS: In immobilized patients with stroke, traumatic brain injury, or spinal cord injury, VTE screening should be performed at different schedules based on the timing of initiation of pharmacologic prophylaxis. In patients who did not start prophylaxis during the first 2 days of admission to the hospital, the majority of the VTE events occurred during the first 10 days.


Assuntos
Repouso em Cama/efeitos adversos , Lesões Encefálicas/terapia , Admissão do Paciente , Traumatismos da Coluna Vertebral/terapia , Acidente Vascular Cerebral/terapia , Tempo para o Tratamento , Tromboembolia Venosa/prevenção & controle , Adulto , Idoso , Idoso de 80 Anos ou mais , Lesões Encefálicas/complicações , Lesões Encefálicas/diagnóstico , Feminino , Hospitais Comunitários , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco , Traumatismos da Coluna Vertebral/complicações , Traumatismos da Coluna Vertebral/diagnóstico , Acidente Vascular Cerebral/complicações , Acidente Vascular Cerebral/diagnóstico , Fatores de Tempo , Resultado do Tratamento , Ultrassonografia , Tromboembolia Venosa/diagnóstico por imagem , Tromboembolia Venosa/etiologia , Adulto Jovem
13.
Int Orthop ; 43(5): 1271-1274, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-30554261

RESUMO

AIM OF THE STUDY: The purpose of this historic review is to summarize the life and work of Avicenna (980-1037) and his contribution to the diagnosis and treatment of spinal deformities and trauma. METHOD: We conducted an extensive search in libraries as well as online in Pubmed and Google Scholar. RESULTS: Avicenna in his work Canon of Medicine combines the knowledge of ancient Greek and Roman physicians and surgeons and he combines them with the extensive of Arabic medicine and pharmacology. CONCLUSION: Avicenna made an impact with his medical writings in which he summarized the works of ancient Greek and Roman physicians like Hippocrates and Galen with the influence of medieval authors and the knowledge of the Arabic medicine and pharmacology. His descriptions and comments in his work Canon of Medicine summarize and comment the work of his predecessors and it remained a work of reference until at least the sixteenth century.


Assuntos
Medicina Arábica/história , Obras Médicas de Referência , Doenças da Coluna Vertebral/história , Traumatismos da Coluna Vertebral/história , Coluna Vertebral/anormalidades , História Medieval , Humanos , Pérsia , Doenças da Coluna Vertebral/congênito , Doenças da Coluna Vertebral/diagnóstico , Doenças da Coluna Vertebral/terapia , Traumatismos da Coluna Vertebral/diagnóstico , Traumatismos da Coluna Vertebral/terapia , Coluna Vertebral/anatomia & histologia , Coluna Vertebral/fisiologia
14.
J Pediatr Orthop ; 39(5): e339-e342, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30507861

RESUMO

BACKGROUND: Safe and effective clearance of the pediatric cervical spine presents a challenging problem due to a myriad of reasons, which has often led to further imaging studies such as computed tomographic (CT) scans being performed, exposing the pediatric patient to significant radiation with a potential increased cancer risk. The goal of this study is to develop an effective algorithm for cervical spine clearance that minimizes radiation exposure. METHODS: A cervical spine clearance protocol had been utilized in our institution from 2002 to 2011. In October 2012, the protocol was revised to provide indications for appropriate imaging by utilizing repeat "next day" physical examination. In 2014, the protocol was again revised with the desired goal of decreasing the use of CT scans through increased involvement of the Spine Service. A retrospective review was commenced using information from the Trauma Database from 2011 to 2014. Three groups were analyzed according to which protocol the patients were evaluated under: 2011, 2012, and 2014 protocols. RESULTS: During the study period, 762 patients underwent cervical spine clearance; 259 (2011 protocol), 360 (2012 protocol), and 143 (2014 protocol). The average age of all patients was 8.8 years, with 28% of patients younger than 5 years of age. There were no missed or delayed diagnoses of cervical spine injury. The use of CT scans decreased during the study period from 90% (2011 protocol) to 42% (2012 protocol) to 28.7% (2014 protocol). There was an increase in time to removal of the cervical collar at 13 to 24 hours from 8% (2011 protocol) to 22% (2012 protocol) to 19% (2014 protocol). This was not associated with an increase in hospital length of stay, which averaged 2.51 days (2011 protocol), 2.45 days (2012 protocol), and 2.27 days (2014 protocol). CONCLUSIONS: Repeat "next day" clinical examinations and increased involvement of the Spine Service decreased radiation exposure without compromising the diagnosis of cervical spine injury or increasing the length of stay at a Level One Pediatric Trauma Center in this pilot study. LEVEL OF EVIDENCE: Level 4-case series.


Assuntos
Vértebras Cervicais , Exame Físico/métodos , Exposição à Radiação , Traumatismos da Coluna Vertebral/diagnóstico , Algoritmos , Vértebras Cervicais/diagnóstico por imagem , Vértebras Cervicais/lesões , Criança , Pré-Escolar , Feminino , Humanos , Masculino , Projetos Piloto , Exposição à Radiação/prevenção & controle , Exposição à Radiação/normas , Estudos Retrospectivos , Fatores de Tempo , Tomografia Computadorizada por Raios X/métodos , Tomografia Computadorizada por Raios X/normas , Centros de Traumatologia/estatística & dados numéricos
15.
Rev Med Liege ; 73(12): 645-649, 2018 Dec.
Artigo em Francês | MEDLINE | ID: mdl-30570237

RESUMO

Cervical spine injuries are a regular reason for consultation in general practice or pediatric emergencies. In many cases, it is difficult to distinguish between whether or not a radiological assessment is necessary. We propose in this article a management strategy based on clinical scores simple to achieve in order to avoid unnecessary radiological examinations for children.


Assuntos
Algoritmos , Vértebras Cervicais/lesões , Traumatismos da Coluna Vertebral/diagnóstico , Vértebras Cervicais/diagnóstico por imagem , Criança , Humanos , Exame Neurológico
16.
Handb Clin Neurol ; 158: 345-351, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30482362

RESUMO

Cervical spine trauma is a relatively rare but catastrophic event in sports. These critical situations depend on sports medicine personnel understanding every aspect of sideline care to ensure a safe and successful evaluation. This involves thorough preparation, vigilant observation of the sporting event to detect the possible mechanism of injury, and initiation of the appropriate action plan when a potentially catastrophic injury is suspected. Sideline management of cervical spine trauma requires the appropriate primary survey, with spine stabilization if necessary, secondary survey for concomitant injury, and, potentially, initiation of full spine stabilization with a spine board. In this chapter, our primary focus is discussion of the sideline evaluation of cervical spine trauma, and sideline practices designed to stabilize the athlete and minimize risk for further injury.


Assuntos
Traumatismos em Atletas/complicações , Traumatismos da Coluna Vertebral/diagnóstico , Traumatismos da Coluna Vertebral/etiologia , Humanos
18.
Eur J Radiol ; 108: 283-287, 2018 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-30297097

RESUMO

The pattern and mechanism of sports injuries in disabled athletes and the challenges to overcome such injuries is well documented. However, there is limited information regarding the specifics of medical imaging of the injured disabled athletes. This article, reflects on the experience gained during the organisation and provision of the imaging services for the London 2012 Paralympic games. The knowledge gained during these games, in conjunction with information from the existing literature on sporting injuries in disabled athletes can help planning and delivery of well-coordinated imaging services at major disability sporting events.


Assuntos
Traumatismos em Atletas/diagnóstico , Esportes para Pessoas com Deficiência , Atletas/estatística & dados numéricos , Pessoas com Deficiência , Fraturas Ósseas/diagnóstico , Humanos , Londres , Imagem por Ressonância Magnética , Músculo Esquelético/lesões , Lesões dos Tecidos Moles/diagnóstico , Traumatismos da Coluna Vertebral/diagnóstico , Tomografia Computadorizada por Raios X , Ultrassonografia
20.
Emerg Med J ; 35(10): 614-618, 2018 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-30032123

RESUMO

OBJECTIVE: Previous 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 and validated a clinical decision rule (Rule 1) for detecting cervical spine injury (CSI) on CT in a single-centre study. This recommended CT for patients with (1) GCS score <14, (2) GCS 14-15 and posterior cervical tenderness or neurological deficit, (3) age ≥60 years and fall down stairs, or (4) age <60 and injured in a motorcycle collision or fallen from height. This study assessed the accuracy and reliability of this rule and refined the rule. METHODS: We conducted a prospective, dual-centre study at two Japanese EDs between August 2012 and March 2014. Patients with head or neck injury ≥16 years of age were included. Clinical data were collected from medical records. Imaging was at the discretion of the treating physician. CSI was diagnosed as a fracture or dislocation seen on CT; patients who were not imaged were followed for 14 days. We analysed the sensitivity and specificity of Rule 1 and refined it post hoc using recursive partitioning. RESULTS: 1192 patients were enrolled. 927 completed follow-up. Of these, 584 (63.0%) underwent CT imaging and 38 had CSI. Sensitivity and specificity of Rule 1 were 92.1% (95% CI 79.2% to 97.3%) and 58.6% (95% CI 55.4% to 61.9%). A second rule (Rule 2) was derived recommending CT for those with any of the following: GCS <14, cervical tenderness, neurological deficit or mechanism of injury (fall down stairs, motorcycle collision or fall from height) without age limits. Sensitivity and specificity were 100% (95% CI 90.8% to 100%) and 51.9% (95% CI 48.6% to 55.2%), respectively. CONCLUSIONS: Our initial CT decision rule had lower sensitivity than in our initial validation study. A refined decision rule based on GCS, neck tenderness, neurological deficit and mechanism of injury showed excellent sensitivity with a small loss of specificity. Rule 2 will now need validation in an independent cohort.


Assuntos
Traumatismos Craniocerebrais/complicações , Técnicas de Apoio para a Decisão , Lesões do Pescoço/complicações , Traumatismos da Coluna Vertebral/diagnóstico , Adulto , Idoso , Medula Cervical/lesões , Traumatismos Craniocerebrais/diagnóstico , Feminino , Escala de Coma de Glasgow , Humanos , Japão , Masculino , Pessoa de Meia-Idade , Lesões do Pescoço/diagnóstico , Estudos Prospectivos , Radiografia/métodos , Tomografia Computadorizada por Raios X/métodos
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