Identifying survivors with traumatic craniocervical dissociation: a retrospective study

Area of Science:

• Trauma Surgery
• Neurosurgery
• Emergency Medicine

Background:

• Traumatic craniocervical dissociation (CCD) is a severe injury often fatal at the scene.
• Increasingly, patients with CCD are surviving to reach medical facilities.
• Identifying predictors of survival is crucial for patient management.

Purpose of the Study:

• To identify clinical and radiographic factors differentiating survivors from non-survivors of CCD.
• To understand the presentation of patients with CCD who survive.

Main Methods:

• Retrospective review of trauma registry and medical examiner databases (2001-2006).
• Inclusion of patients aged 12+ diagnosed with CCD via ICD-9, X-ray, or CT.
• Analysis of demographics, injury mechanism, clinical presentation, interventions, and radiographic findings.

Main Results:

• Seven out of 69 CCD patients survived to discharge.
• Survivors had significantly higher Glasgow Coma Scale (GCS) scores and were more often normotensive.
• Non-survivors were more likely to have a basion-dental interval (BDI) greater than or equal to 16mm and cervical cord injury.

Conclusions:

• Trauma patients with CCD, cervical cord injury, requiring CPR, and GCS of 3 have a grim prognosis.
• A wider basion-dental interval (BDI) is a significant predictor of mortality in craniocervical dissociation injuries.