Trauma/Critical Services, St. Elizabeth Health Center, Youngstown, Ohio 44501, USA.
J Neurotrauma. 2011 Jun;28(6):1009-19. doi: 10.1089/neu.2010.1301. Epub 2011 Jan 9.
Cervical spine (CS) magnetic resonance imaging (MRI) and collar use may prevent quadriplegia, yet create brain injury. We developed a computer model to assess the effect of CS management strategies on outcomes in comatose, blunt trauma patients with extremity movement and a negative CS CT scan. Strategies include early collar removal (ECR), ECR & MRI, late collar removal (LCR), and LCR & MRI. MRI risks include hypoxia, hypotension, increased intracranial pressure (↑ICP), and ventilator-associated pneumonia (VAP). LCR risks include ↑ICP, VAP, and delirium. Model elements include Quadriplegia and Primary, Secondary, LCR, and MRI Brain Injury. The Monte Carlo simulation determines health outcomes (Functional Survival versus Quadriplegia, Severe Brain Disability, or Dead). Utility values are Functional Survival 0.90, Quadriplegia 0.20, Severe Brain Disability 0.10, and Dead 0.00. Years of life expectancy are Functional Survival 39.5, Quadriplegia 20.0, Severe Brain Disability 20.0, and Dead 0.0. Unstable CS rate 2.5%: Functional Survival/1,000: Unstable Patients: ECR 384, LCR 350, LCR & MRI 332, ECR & MRI 331; High-Risk Patients: ECR 161, LCR 151, LCR & MRI 140, ECR & MRI 153; Stable Patients: ECR 596, LCR 587, LCR & MRI 573, ECR & MRI 595. Quality-Adjusted Life Months for Unstable, High-Risk, and Stable Patients are greater with ECR; Stable Patient ECR and ECR & MRI are similar. Unstable CS rate 0.5%: Functional Survival/1000: Unstable Patients: ECR 394, LCR 352, LCR & MRI 332, ECR & MRI 332; High-Risk Patients: ECR 164, LCR 151, LCR & MRI 140, ECR & MRI 152; Stable Patients: ECR 611, LCR 592, LCR & MRI 576, ECR & MRI 598. Quality-Adjusted Life Months for Unstable, High-Risk, and Stable Patients are greater with ECR. LCR and MRI brain injury results in losses of functional survivorship that exceed those from quadriplegia. Model results suggest that early collar removal without cervical spine MRI is a reasonable, and likely the preferable, cervical spine management strategy for comatose, blunt trauma patients with extremity movement and a negative cervical spine CT scan.
颈椎（CS）磁共振成像（MRI）和颈托的使用可能预防四肢瘫痪，但会造成脑损伤。我们开发了一种计算机模型，以评估昏迷、钝性创伤伴四肢活动和颈椎 CT 扫描阴性患者的颈椎管理策略对结果的影响。策略包括早期去除颈托（ECR）、ECR 和 MRI、晚期去除颈托（LCR）和 LCR 和 MRI。MRI 风险包括缺氧、低血压、颅内压升高（↑ICP）和呼吸机相关性肺炎（VAP）。LCR 风险包括↑ICP、VAP 和谵妄。模型元素包括四肢瘫痪和原发性、继发性、LCR 和 MRI 脑损伤。蒙特卡罗模拟确定健康结果（功能存活与四肢瘫痪、严重脑残疾或死亡）。效用值为功能存活 0.90、四肢瘫痪 0.20、严重脑残疾 0.10 和死亡 0.00。预期寿命为功能存活 39.5 年、四肢瘫痪 20.0 年、严重脑残疾 20.0 年和死亡 0.0 年。颈椎不稳定率 2.5%：功能存活/1000：不稳定患者：ECR 384、LCR 350、LCR 和 MRI 332、ECR 和 MRI 331；高危患者：ECR 161、LCR 151、LCR 和 MRI 140、ECR 和 MRI 153；稳定患者：ECR 596、LCR 587、LCR 和 MRI 573、ECR 和 MRI 595。不稳定、高危和稳定患者的质量调整生命月数（Quality-Adjusted Life Months）采用 ECR 治疗效果更佳；稳定患者 ECR 和 ECR & MRI 相似。颈椎不稳定率 0.5%：功能存活/1000：不稳定患者：ECR 394、LCR 352、LCR 和 MRI 332、ECR 和 MRI 332；高危患者：ECR 164、LCR 151、LCR 和 MRI 140、ECR 和 MRI 152；稳定患者：ECR 611、LCR 592、LCR 和 MRI 576、ECR 和 MRI 598。不稳定、高危和稳定患者的质量调整生命月数（Quality-Adjusted Life Months）采用 ECR 治疗效果更佳。LCR 和 MRI 脑损伤导致的功能生存损失超过四肢瘫痪。模型结果表明，对于昏迷、钝性创伤伴四肢活动和颈椎 CT 扫描阴性的患者，不进行颈椎 MRI 的早期去除颈托是一种合理的、可能更优的颈椎管理策略。
