Difference between revisions of "Blunt neck trauma"

(Evaluation)
 
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==Evaluation==
 
==Evaluation==
 +
===Workup===
 +
*Consider x-ray or non-contrast cervical CT to evaluate for bone/cord injury (see below)
 +
**May later consider cervical MRI to further evaluate for cord injury
 +
*Consider CTA neck with contrast to evaluate for vascular injury (see below)
 +
 
===General Approach===
 
===General Approach===
 
*If concern for cervical spine injury, use a [[cervical spine clearance]] decision rule to determine need for imaging
 
*If concern for cervical spine injury, use a [[cervical spine clearance]] decision rule to determine need for imaging

Latest revision as of 12:51, 22 February 2020

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)

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. [1]

Differential Diagnosis

Neck Trauma

Other

Evaluation

Workup

  • Consider x-ray or non-contrast cervical CT to evaluate for bone/cord injury (see below)
    • May later consider cervical MRI to further evaluate for cord injury
  • Consider CTA neck with contrast to evaluate for vascular injury (see below)

General Approach

Management

Disposition

  • Based on specific diagnosis

See Also

External Links

References

  1. Desai NK, et al. Screening CT angiography for pediatric blunt cerebrovascular injury with emphasis on the cervical “seat- belt sign.” AJNR Am J Neuroradiol. 2014 Sep;35(9):1836-40. PMID: 24722311.