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Cervical spine traumatic epidural haematomas: Incidence and characteristics
Lisa Brichko1,2, Birinder Giddey2, Jin Tee3,4
1Emergency and Trauma Centre, The Alfred Hospital, Melbourne, Victoria, Australia.
Insights
Cervical spine traumatic epidural haematomas (CSTEH) are common in trauma patients and linked to poor outcomes. Early MRI is crucial for diagnosis, as CT scans may miss these critical injuries.
Area of Science:
- Neurosurgery
- Trauma Surgery
- Radiology
Background:
- Cervical spine traumatic epidural haematomas (CSTEH) can lead to severe neurological deficits.
- Prompt identification and management of CSTEH are critical for patient outcomes.
Purpose of the Study:
- To determine the incidence of CSTEH in trauma patients.
- To characterize the features and outcomes associated with CSTEH.
- To evaluate diagnostic accuracy of imaging modalities for CSTEH.
Main Methods:
- Retrospective analysis of consecutive adult patients diagnosed with CSTEH at a Level 1 Trauma Centre over four years.
- Data collection included patient demographics, injury mechanisms, comorbidities, radiological findings, surgical interventions, and neurological outcomes.
- Review of medical records and imaging interpretations (CT and MRI) for CSTEH diagnosis.
Main Results:
- CSTEH incidence was 0.6% of all trauma admissions and 9.1% of cervical spine injuries.
- Half of CSTEH patients (50.9%) presented with neurological deficits.
- MRI diagnosed CSTEH in 75.4% of cases, with 13.1% having normal initial CT scans; 7.4% mortality and 44.6% required surgery.
Conclusions:
- CSTEH occurs with significant frequency in trauma populations and is associated with substantial morbidity and mortality.
- High clinical suspicion is necessary for timely diagnosis.
- Urgent MRI is essential for accurate CSTEH diagnosis, as it is frequently missed on initial CT imaging.
Objective:
Cervical spine traumatic epidural haematomas (CSTEH) can cause potentially devastating neurological deficits if not promptly identified. Study aims were to determine the incidence, characteristics and outcomes for patients with CSTEH.
Methods:
A retrospective study was performed at a tertiary hospital with an adult Level 1 Trauma Centre on all consecutive patients diagnosed with CSTEH over a 4 year period. Medical record review was undertaken for all patients with the diagnoses of CSTEH to identify patient characteristics including age, mechanism of injury and co-morbid conditions. Additional data was extracted regarding radiology interpretation, surgical interventions, thromboembolic chemoprophylaxis use, discharge disposition and neurological outcomes.
Results:
A total of 27 888 patients were admitted with traumatic injuries between 1 July 2010 and 30 June 2014, of which 1916 patients sustained cervical spine injuries. The incidence of CSTEH was 0.6% among all trauma patients and 9.1% among patients with any cervical spine injury. Of those with CSTEH, 89 patients (50.9%) had neurological deficits consistent with the anatomical location of the epidural haematoma. Magnetic resonance imaging diagnosed CSTEH in 132 patients (75.4%), of whom 23 patients (13.1%) had normal computed tomography cervical spine imaging. Among the patients diagnosed with CSTEH, 13 (7.4%) died and 78 (44.6%) required cervical spine surgical decompressions.
Conclusion:
This study shows a high incidence of CSTEH among trauma patients. CSTEH is associated with significant morbidity and mortality. High clinical vigilance is required to allow the request and acquisition of urgent magnetic resonance imaging to diagnose CSTEH as the entity is often not evident on initial cervical spine computed tomography investigations.
