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Intracranial hemorrhage as a predictor of occult cervical-spine fracture
1Department of Emergency Medicine, Valley Medical Center, Fresno, California.
Insights
Intracranial hemorrhage in blunt trauma patients does not predict occult cervical-spine fractures. This study found no significant association between head injuries and hidden spinal fractures, challenging previous assumptions in trauma care.
Area of Science:
- Trauma surgery
- Neurosurgery
- Radiology
Background:
- Occult cervical-spine fractures are a concern in blunt trauma.
- Intracranial hemorrhage is common in severe head injuries.
Purpose of the Study:
- To investigate if intracranial hemorrhage predicts occult cervical-spine fractures in blunt trauma patients.
Main Methods:
- Prospective, cross-sectional study at a Level I trauma center.
- Included 93 blunt trauma patients with Glasgow Coma Scale ≤ 12.
- Utilized cervical-spine and head CT scans, with blinded radiologist interpretation.
Main Results:
- 54 patients had intracranial hemorrhage; 2 had upper cervical-spine fractures (1 occult).
- 39 patients had no intracranial hemorrhage; 2 had upper cervical-spine fractures (1 occult).
- Fisher's exact test showed no significant difference in occult fracture rates.
Conclusions:
- Intracranial hemorrhage is not a reliable predictor of occult cervical-spine fractures.
- Findings suggest current diagnostic assumptions may need reevaluation.
- Further research may be needed to identify reliable predictors.
Study Objective:
To determine whether intracranial hemorrhage is a predictor of occult cervical-spine fracture.
Design:
A prospective, cross-sectional study.
Setting:
University-affiliated Level I trauma center.
Participants:
Ninety-three blunt trauma victims with a Glasgow Coma Scale score of 12 or less. Exclusion criteria were incomplete radiographic evaluation caused by hemodynamic instability, death, or other reasons.
Interventions:
The study protocol required that all patients undergo a five-view cervical-spine trauma series, head computed tomography (CT), and upper cervical-spine CT. Cervical-spine radiographs and CT scans were read by two radiologists blinded to each other's interpretations. The results were compared with each patient's head CT diagnosis. Medical records were reviewed for demographic information and mechanism of injury.
Results:
Of the 93 patients, 54 had intracranial hemorrhage noted on CT scan; two of these patients had an upper cervical-spine fracture, but only one was an occult cervical-spine fracture. Thirty-nine patients had no intracranial hemorrhage; two patients had an upper cervical-spine fracture, but only one had an occult cervical-spine fracture. Fisher's exact test showed no significant difference between the rate of occult cervical-spine fracture between patients with and without hemorrhage.
Conclusion:
Despite a high percentage of patients with traumatic intracranial hemorrhage, our study failed to demonstrate that intracranial hemorrhage is predictor of occult cervical-spine fracture.