Blunt neck trauma

Background

• Suspect vascular damage to cord, if discrepancy between neuro deficit and level of spinal column injury
• Spinal cord injury is more likely if anterior (vertebral bodies) AND posterior (spinal canal) columns are disrupted

Clinical Features

• Signs of life-threatening neck or upper thoracic injury (look for TWELVE):

Tracheal deviation,

Wounds,

External markings,

Laryngeal disruption,

Venous distention,

Emphysema (surgical)

• Features may include signs and symptoms of:
  • Spinal cord injury
  • Vertebral and Carotid Artery Dissection
  • Laryngeal or tracheal injury

Differential Diagnosis

Neck Trauma

• Penetrating neck trauma
• Blunt neck trauma
  • Vertebral and carotid artery dissection
  • Strangulation
  • Whiplash injury
• Cervical injury
  • Cervical fractures and dislocations
  • Cervical injury (peds)
  • Cervical spine clearance
• Neurogenic shock
• Spinal cord injury

Other

• Head trauma
• Thoracic trauma

Evaluation

General Approach

• If concern for cervical spine injury, use a cervical spine clearance decision rule to determine need for imaging
• Perform a neuro exam, to determine concern for spinal cord injury
• If concern for vascular injury, use the Denver screening criteria

Pediatrics

• In a small study of 42 patients with a cervical seatbelt sign there were no isolated cerebrovascular injuries. For pediatric patients in a motor vehicle collision, the presence of an isolated seatbelt sign was not associated with any cases of cerebrovascular injury.

Management

• Prehospital
  • See the NAEMSP National Guidelines for Spinal Immobilization
• Hospital
  • Secure ABCs
  • See cervical spine clearance
  • See specific diagnosis

Disposition

• Based on specific diagnosis

See Also

• Penetrating neck trauma
• Cervical spine clearance
• Canadian cervical spine rule
• NEXUS cervical spine rule
• Strangulation
• Vertebral and carotid artery dissection

External Links

• Blunt Neck Trauma from CoreEM