Missed injuries associated with spinal cord trauma

Area of Science:

• Trauma Surgery
• Neurosurgery
• Emergency Medicine

Background:

• High-energy trauma, often from vehicular accidents, frequently leads to multisystem trauma.
• Spinal cord injuries (SCI) can be accompanied by other injuries that may be overlooked during initial resuscitation.
• Delayed diagnosis of associated injuries can complicate patient management and outcomes.

Purpose of the Study:

• To investigate the frequency and consequences of "missed injuries" in patients with spinal cord trauma.
• To identify the types of injuries that are commonly missed in the context of SCI.
• To determine the impact of delayed diagnosis on patient outcomes.

Main Methods:

• Retrospective chart review of 24 patients with spinal cord injuries over a 9-year period.
• Analysis of initial presentation, Glasgow Coma Scale (GCS), and Revised Trauma Score (RTS).
• Identification and classification of initially undiagnosed spinal and nonspinal injuries.

Main Results:

• 42% of patients (10 out of 24) had 11 initially undiagnosed injuries (5 spinal, 6 nonspinal).
• Missed spinal injuries included fractures at C5-6, C4, T7, and L1. Nonspinal injuries included pneumothorax, hemopneumothorax, diaphragmatic paralysis, and renal contusion.
• Patients with and without missed injuries had similar initial trauma scores; however, delayed diagnosis led to prolonged hospital stays and/or additional surgeries.

Conclusions:

• Missed injuries are common in patients with spinal cord trauma and can significantly impact patient care.
• Early and comprehensive evaluation is crucial to identify all injuries in trauma patients, including those with SCI.
• Prompt diagnosis and management of all associated injuries are essential to prevent prolonged morbidity.