Oto Brandon, Corey Domenic John, Oswald James, Sifford Derek, Walsh Brooks
University of New England, Portland, ME.
Northeastern University, Boston, MA.
Acad Emerg Med. 2015 Oct;22(10):1200-12. doi: 10.1111/acem.12765. Epub 2015 Sep 22.
The objectives were to review published reports of secondary neurologic deterioration in the early stages of care after blunt spinal trauma and describe its nature, context, and associated risk factors.
The authors searched the MEDLINE, EMBASE, and CINAHL databases for English-language studies. Cases were included meeting the criteria age 16 years or older, nonpenetrating trauma, and experiencing neurologic deterioration during prehospital or emergency department (ED) care prior to definitive management (e.g., discharge, spinal clearance by computed tomography, admission to an inpatient service, or surgical intervention). Results were qualitatively analyzed for characteristics and themes.
Forty-one qualifying cases were identified from 12 papers. In 30 cases, the new deficits were apparently spontaneous and were not detected until routine reassessment. In 12 cases the authors did attribute deterioration to temporally associated precipitants, seven of which were possibly iatrogenic; these included removal of a cervical collar, placement of a halo device, patient agitation, performance of flexion/extension films, "unintentional manipulation," falling in or near the ED, and forced collar application in patients with ankylosing spondylitis. Thirteen cases occurred during prehospital care, none of them sudden and movement-provoked, and all reported by a single study.
Published reports of early secondary neurologic deterioration after blunt spinal trauma are exceptionally rare and generally poorly documented. High-risk features may include altered mental status and ankylosing spondylitis. It is unclear how often events are linked with spontaneous patient movement and whether such events are preventable.
回顾钝性脊柱创伤后早期护理中继发性神经功能恶化的已发表报告，并描述其性质、背景及相关危险因素。
作者检索了MEDLINE、EMBASE和CINAHL数据库中的英文研究。纳入标准为年龄16岁及以上、非穿透性创伤、在确定性治疗（如出院、计算机断层扫描脊柱检查、住院治疗或手术干预）之前的院前或急诊科护理期间出现神经功能恶化的病例。对结果进行定性分析以确定特征和主题。
从12篇论文中确定了41例符合条件的病例。在30例中，新的神经功能缺损显然是自发出现的，直到常规重新评估时才被发现。在12例中，作者确实将神经功能恶化归因于与时间相关的诱因，其中7例可能是医源性的；这些诱因包括去除颈托、佩戴头环装置、患者躁动、进行屈伸位X线片检查、“意外操作”、在急诊科内或附近跌倒以及强直性脊柱炎患者强制佩戴颈托。13例发生在院前护理期间，均非突然发生且无运动诱发，所有这些均来自一项研究报告。
钝性脊柱创伤后早期继发性神经功能恶化的已发表报告极为罕见，且通常记录不完善。高危特征可能包括精神状态改变和强直性脊柱炎。目前尚不清楚这些事件与患者自发运动的关联频率，以及此类事件是否可预防。
