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Head injuries and the risk of concurrent cervical spine fractures

Background Cervical spine injuries of variable severity are common among patients with an acute traumatic brain injury (TBI). We hypothesised that TBI patients with positive head computed tomography (CT) scans would have a significantly higher risk of having an associated cervical spine fracture com... Full description

Journal Title: Acta neurochirurgica 2017-03-03, Vol.159 (5), p.907-914
Main Author: Thesleff, Tuomo
Other Authors: Kataja, Anneli , Öhman, Juha , Luoto, Teemu M
Format: Electronic Article Electronic Article
Language: English
Subjects:
Publisher: Vienna: Springer Vienna
ID: ISSN: 0001-6268
Link: https://www.ncbi.nlm.nih.gov/pubmed/28258310
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title: Head injuries and the risk of concurrent cervical spine fractures
format: Article
creator:
  • Thesleff, Tuomo
  • Kataja, Anneli
  • Öhman, Juha
  • Luoto, Teemu M
subjects:
  • Accidental Falls - statistics & numerical data
  • Accidents, Traffic - statistics & numerical data
  • Adult
  • brain injuries
  • cervical spine fractures
  • Cervical Vertebrae - diagnostic imaging
  • Cervical Vertebrae - injuries
  • computed tomography
  • Craniocerebral Trauma - complications
  • Craniocerebral Trauma - diagnostic imaging
  • Craniocerebral Trauma - epidemiology
  • Craniocerebral Trauma - etiology
  • Female
  • head injury
  • Humans
  • Interventional Radiology
  • Male
  • Medicine
  • Medicine & Public Health
  • Middle Aged
  • Minimally Invasive Surgery
  • Neurology
  • Neuroradiology
  • Neurosciences
  • Neurosurgery
  • Neurotieteet
  • Original Article - Brain Injury
  • Spinal Fractures - diagnostic imaging
  • Spinal Fractures - epidemiology
  • Spinal Fractures - etiology
  • spinal injuries
  • Surgical Orthopedics
  • Tomography, X-Ray Computed
ispartof: Acta neurochirurgica, 2017-03-03, Vol.159 (5), p.907-914
description: Background Cervical spine injuries of variable severity are common among patients with an acute traumatic brain injury (TBI). We hypothesised that TBI patients with positive head computed tomography (CT) scans would have a significantly higher risk of having an associated cervical spine fracture compared to patients with negative head CT scans. Method This widely generalisable retrospective sample was derived from 3,023 consecutive patients, who, due to an acute head injury (HI), underwent head CT at the Emergency Department of Tampere University Hospital (August 2010–July 2012). Medical records were reviewed to identify the individuals whose cervical spine was CT-imaged within 1 week after primary head CT due to a clinical suspicion of a cervical spine injury (CSI) ( n  = 1,091). Results Of the whole cranio-cervically CT-imaged sample ( n  = 1,091), 24.7% ( n  = 269) had an acute CT-positive TBI. Car accidents 22.4% ( n  = 244) and falls 47.8% ( n  = 521) were the most frequent injury mechanisms. On cervical CT, any type of fracture was found in 6.6% ( n  = 72) and dislocation and/or subluxation in 2.8% ( n  = 31) of the patients. The patients with acute traumatic intracranial lesions had significantly ( p  = 0.04; OR = 1.689) more cervical spine fractures (9.3%, n  = 25) compared to head CT-negative patients (5.7%, n  = 47). On an individual cervical column level, head CT positivity was especially related to C6 fractures ( p  = 0.031, OR = 2.769). Patients with cervical spine fractures ( n  = 72) had altogether 101 fractured vertebrae, which were most often C2 (22.8, n  = 23), C7 (19.8%, n  = 20) and C6 (16.8%, n  = 17). Conclusions Head trauma patients with acute intracranial lesions on CT have a higher risk for cervical spine fractures in comparison to patients with a CT-negative head injury. Although statistically significant, the difference in fracture rate was small. However, based on these results, we suggest that cervical spine fractures should be acknowledged when treating CT-positive TBIs.
language: eng
source:
identifier: ISSN: 0001-6268
fulltext: no_fulltext
issn:
  • 0001-6268
  • 0942-0940
url: Link


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titleHead injuries and the risk of concurrent cervical spine fractures
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descriptionBackground Cervical spine injuries of variable severity are common among patients with an acute traumatic brain injury (TBI). We hypothesised that TBI patients with positive head computed tomography (CT) scans would have a significantly higher risk of having an associated cervical spine fracture compared to patients with negative head CT scans. Method This widely generalisable retrospective sample was derived from 3,023 consecutive patients, who, due to an acute head injury (HI), underwent head CT at the Emergency Department of Tampere University Hospital (August 2010–July 2012). Medical records were reviewed to identify the individuals whose cervical spine was CT-imaged within 1 week after primary head CT due to a clinical suspicion of a cervical spine injury (CSI) ( n  = 1,091). Results Of the whole cranio-cervically CT-imaged sample ( n  = 1,091), 24.7% ( n  = 269) had an acute CT-positive TBI. Car accidents 22.4% ( n  = 244) and falls 47.8% ( n  = 521) were the most frequent injury mechanisms. On cervical CT, any type of fracture was found in 6.6% ( n  = 72) and dislocation and/or subluxation in 2.8% ( n  = 31) of the patients. The patients with acute traumatic intracranial lesions had significantly ( p  = 0.04; OR = 1.689) more cervical spine fractures (9.3%, n  = 25) compared to head CT-negative patients (5.7%, n  = 47). On an individual cervical column level, head CT positivity was especially related to C6 fractures ( p  = 0.031, OR = 2.769). Patients with cervical spine fractures ( n  = 72) had altogether 101 fractured vertebrae, which were most often C2 (22.8, n  = 23), C7 (19.8%, n  = 20) and C6 (16.8%, n  = 17). Conclusions Head trauma patients with acute intracranial lesions on CT have a higher risk for cervical spine fractures in comparison to patients with a CT-negative head injury. Although statistically significant, the difference in fracture rate was small. However, based on these results, we suggest that cervical spine fractures should be acknowledged when treating CT-positive TBIs.
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subjectAccidental Falls - statistics & numerical data ; Accidents, Traffic - statistics & numerical data ; Adult ; brain injuries ; cervical spine fractures ; Cervical Vertebrae - diagnostic imaging ; Cervical Vertebrae - injuries ; computed tomography ; Craniocerebral Trauma - complications ; Craniocerebral Trauma - diagnostic imaging ; Craniocerebral Trauma - epidemiology ; Craniocerebral Trauma - etiology ; Female ; head injury ; Humans ; Interventional Radiology ; Male ; Medicine ; Medicine & Public Health ; Middle Aged ; Minimally Invasive Surgery ; Neurology ; Neuroradiology ; Neurosciences ; Neurosurgery ; Neurotieteet ; Original Article - Brain Injury ; Spinal Fractures - diagnostic imaging ; Spinal Fractures - epidemiology ; Spinal Fractures - etiology ; spinal injuries ; Surgical Orthopedics ; Tomography, X-Ray Computed
ispartofActa neurochirurgica, 2017-03-03, Vol.159 (5), p.907-914
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descriptionBackground Cervical spine injuries of variable severity are common among patients with an acute traumatic brain injury (TBI). We hypothesised that TBI patients with positive head computed tomography (CT) scans would have a significantly higher risk of having an associated cervical spine fracture compared to patients with negative head CT scans. Method This widely generalisable retrospective sample was derived from 3,023 consecutive patients, who, due to an acute head injury (HI), underwent head CT at the Emergency Department of Tampere University Hospital (August 2010–July 2012). Medical records were reviewed to identify the individuals whose cervical spine was CT-imaged within 1 week after primary head CT due to a clinical suspicion of a cervical spine injury (CSI) ( n  = 1,091). Results Of the whole cranio-cervically CT-imaged sample ( n  = 1,091), 24.7% ( n  = 269) had an acute CT-positive TBI. Car accidents 22.4% ( n  = 244) and falls 47.8% ( n  = 521) were the most frequent injury mechanisms. On cervical CT, any type of fracture was found in 6.6% ( n  = 72) and dislocation and/or subluxation in 2.8% ( n  = 31) of the patients. The patients with acute traumatic intracranial lesions had significantly ( p  = 0.04; OR = 1.689) more cervical spine fractures (9.3%, n  = 25) compared to head CT-negative patients (5.7%, n  = 47). On an individual cervical column level, head CT positivity was especially related to C6 fractures ( p  = 0.031, OR = 2.769). Patients with cervical spine fractures ( n  = 72) had altogether 101 fractured vertebrae, which were most often C2 (22.8, n  = 23), C7 (19.8%, n  = 20) and C6 (16.8%, n  = 17). Conclusions Head trauma patients with acute intracranial lesions on CT have a higher risk for cervical spine fractures in comparison to patients with a CT-negative head injury. Although statistically significant, the difference in fracture rate was small. However, based on these results, we suggest that cervical spine fractures should be acknowledged when treating CT-positive TBIs.
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1Accidents, Traffic - statistics & numerical data
2Adult
3brain injuries
4cervical spine fractures
5Cervical Vertebrae - diagnostic imaging
6Cervical Vertebrae - injuries
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8Craniocerebral Trauma - complications
9Craniocerebral Trauma - diagnostic imaging
10Craniocerebral Trauma - epidemiology
11Craniocerebral Trauma - etiology
12Female
13head injury
14Humans
15Interventional Radiology
16Male
17Medicine
18Medicine & Public Health
19Middle Aged
20Minimally Invasive Surgery
21Neurology
22Neuroradiology
23Neurosciences
24Neurosurgery
25Neurotieteet
26Original Article - Brain Injury
27Spinal Fractures - diagnostic imaging
28Spinal Fractures - epidemiology
29Spinal Fractures - etiology
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31Surgical Orthopedics
32Tomography, X-Ray Computed
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abstractBackground Cervical spine injuries of variable severity are common among patients with an acute traumatic brain injury (TBI). We hypothesised that TBI patients with positive head computed tomography (CT) scans would have a significantly higher risk of having an associated cervical spine fracture compared to patients with negative head CT scans. Method This widely generalisable retrospective sample was derived from 3,023 consecutive patients, who, due to an acute head injury (HI), underwent head CT at the Emergency Department of Tampere University Hospital (August 2010–July 2012). Medical records were reviewed to identify the individuals whose cervical spine was CT-imaged within 1 week after primary head CT due to a clinical suspicion of a cervical spine injury (CSI) ( n  = 1,091). Results Of the whole cranio-cervically CT-imaged sample ( n  = 1,091), 24.7% ( n  = 269) had an acute CT-positive TBI. Car accidents 22.4% ( n  = 244) and falls 47.8% ( n  = 521) were the most frequent injury mechanisms. On cervical CT, any type of fracture was found in 6.6% ( n  = 72) and dislocation and/or subluxation in 2.8% ( n  = 31) of the patients. The patients with acute traumatic intracranial lesions had significantly ( p  = 0.04; OR = 1.689) more cervical spine fractures (9.3%, n  = 25) compared to head CT-negative patients (5.7%, n  = 47). On an individual cervical column level, head CT positivity was especially related to C6 fractures ( p  = 0.031, OR = 2.769). Patients with cervical spine fractures ( n  = 72) had altogether 101 fractured vertebrae, which were most often C2 (22.8, n  = 23), C7 (19.8%, n  = 20) and C6 (16.8%, n  = 17). Conclusions Head trauma patients with acute intracranial lesions on CT have a higher risk for cervical spine fractures in comparison to patients with a CT-negative head injury. Although statistically significant, the difference in fracture rate was small. However, based on these results, we suggest that cervical spine fractures should be acknowledged when treating CT-positive TBIs.
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orcididhttps://orcid.org/0000-0001-6757-682X
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