MetroHealth Medical Center, Cleveland, Ohio, USA.
MetroHealth Medical Center, Cleveland, Ohio, USA.
Injury. 2020 Apr;51(4):935-941. doi: 10.1016/j.injury.2020.02.097. Epub 2020 Feb 21.
This study highlights the unnecessarily high suspicion for cervical spine injury among study providers and shows that cervical CT scans were more likely in patients who arrived to the emergency department wearing a cervical collar, even when clinically cleared for suspicion of cervical spine injury by the emergency department provider.
To determine if patients with a cervical collar were more likely to undergo cervical spine imaging than those who arrived to the emergency department without a collar.
Adult trauma patients at a level 1 trauma center over 4 months (n = 1,438) were stratified by acuity (1,2, or 3), mechanism, and known injury cephalad to clavicles, defined as pain, wounds, or hematomas. Cervical spine imaging findings were recorded.
975 patients (67.8%) had cervical CT scans. Twenty-six (1.81%) sustained a fracture or ligamentous injury, all with known injury cephalad to clavicles. 161 (11.2%) patients without injury cephalad to clavicles all had a negative cervical CT. Category 1 patients with gunshot wounds with injury cephalad to clavicles were more likely to have CT if they arrived with a collar versus without (66.7% vs 14.3%, p = 0.027). Category 2 and 3 patients with injury cephalad to clavicles after motor vehicle collision (MVC) (88.2% vs 69.6%, p = 0.011), low energy falls (88.3% vs 59.4%, p < 0.0001), and assault (86.0% vs 37.1%, p < 0.0001) underwent cervical CT more frequently if they arrived wearing a collar. Category 2 and 3 trauma patients without injury cephalad to clavicles were also more likely to undergo CT when wearing a collar after MVC (66.3% vs 21.4%, p = 0.001), low energy fall (81.8% vs 35.3%, p = 0.016), and pedestrian vs MVC (55.6% vs 12.5%, p = 0.04).
Certain trauma patients were more likely to undergo cervical CT if they arrived wearing a cervical collar. No conscious patients without complaints proximal to the clavicles had cervical injury.
本研究强调了研究提供者对颈椎损伤的不必要高度怀疑，并表明即使急诊科提供者临床排除颈椎损伤的可疑，在急诊科佩戴颈托的患者更有可能进行颈椎 CT 扫描。
确定佩戴颈托的患者是否比未佩戴颈托到达急诊科的患者更有可能进行颈椎成像。
在 4 个月内对 1 级创伤中心的成年创伤患者进行分层，按严重程度（1、2 或 3 级）、机制和已知锁骨以上的损伤进行分层，定义为疼痛、伤口或血肿。记录颈椎成像结果。
975 名患者（67.8%）进行了颈椎 CT 扫描。26 名（1.81%）患者发生骨折或韧带损伤，均有锁骨以上的已知损伤。161 名（11.2%）无锁骨以上损伤的患者颈椎 CT 均为阴性。锁骨以上有枪伤且有损伤的 1 类患者，如果佩戴颈托，比未佩戴颈托更有可能进行 CT（66.7%比 14.3%，p=0.027）。锁骨以上有损伤的 2 类和 3 类机动车碰撞（MVC）患者（88.2%比 69.6%，p=0.011）、低能量跌倒（88.3%比 59.4%，p<0.0001）和攻击（86.0%比 37.1%，p<0.0001）的患者如果佩戴颈托，进行颈椎 CT 的频率更高。锁骨以上无损伤的 2 类和 3 类创伤患者，如果在 MVC 后佩戴颈托（66.3%比 21.4%，p=0.001）、低能量跌倒（81.8%比 35.3%，p=0.016）和行人对 MVC（55.6%比 12.5%，p=0.04）后，也更有可能进行 CT。
某些创伤患者如果佩戴颈托到达，更有可能进行颈椎 CT 检查。无明显症状且锁骨以上无不适的意识清醒患者无颈椎损伤。
