Blunt neck trauma

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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
Three column concept of spinal fracture stability

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)

Differential Diagnosis

Blunt Neck Trauma

Other

Evaluation

Fracture

NEXUS Cervical Spine Rule

Radiography is not necessary if the patient satisfies ALL of the following low risk criteria:

  • No midline cervical tenderness
  • No focal neuro deficits
  • Normal alertness
  • No intoxication
  • No painful distracting injury

C-spine imaging should be considered unless the patient meets all of the above low risk criteria[1] [2]

^If find injury consider CT C-spine, x-ray rest of spine

Spinal cord trauma

  • Neuro exam

Vertebral and Carotid Artery Dissection

The Denver Screening Criteria are divided into risk factors and signs and symptoms

Signs and Symptoms

  • Focal neurologic deficit
  • Arterial Hemorrhage
  • Cervical Bruit or Thrill (<50yo)
  • Infarct on Head CT
  • Expanding Neck Hematoma
  • Neuro exam inconsistent with Head CT

Risk Factors

  • Midface Fractures
  • Cervical Spine Injuries
  • Basilar Skull Fracture
  • GCS<8
  • Hanging with Anoxic Brain Injury
  • Seat belt abrasion or other soft tissue injury of the anterior neck resulting in significant swelling or altered mental status
    • Isolated seatbelt sign without other neurologic symptoms has not been identified as a risk factor[3][4]

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. [5]

Management

Disposition

  • Based on specific diagnosis

See Also

References

  1. 27. Hoffman JR, et al. Low-risk criteria for cervical-spine radiography in blunt trauma: a prospective study. Ann Emerg Med 1992;21:1454-60.
  2. Mahadevan, et al. Interrater reliability of cervical spine injury criteria inpatients with blunt trauma. Ann Emerg Med1998;31:197-201
  3. DiPerna CA, Rowe VL, Terramani TT, et al. Clinical importance of the “seat belt sign” in blunt trauma to the neck. Am Surg. 2002;68:441–445
  4. Rozycki GS, Tremblay L, Feliciano DV, et al. A prospective study for the detection of vascular injury in adult and pediatric patients with cervicothoracic seat belt signs. J Trauma. 2002;52:618–623; discussion 623–624
  5. 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.