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Distracting Painful Injuries Associated with Cervical Spinal Injuries in Blunt Trauma
Author(s) -
Ullrich Ann,
Hendey Gregory W.,
Geiderman Joel,
Shaw Sandi G.,
Hoffman Jerome,
Mower William R.
Publication year - 2001
Publication title -
academic emergency medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.221
H-Index - 124
eISSN - 1553-2712
pISSN - 1069-6563
DOI - 10.1111/j.1553-2712.2001.tb00542.x
Subject(s) - medicine , blunt trauma , blunt , radiography , trauma center , surgery , spinal injury , soft tissue , spinal trauma , observational study , cervical vertebrae , cervical spine , cervical spine injury , radiology , retrospective cohort study , spinal cord injury , spinal cord , psychiatry
. Distracting painful injuries (DPIs) may mask symptoms of spinal injury in blunt trauma victims and form an important element in a decision instrument used to identify individuals who require cervical spine radiography. Objective: To identify the types and frequencies of injuries that actually act as DPIs among blunt trauma patients undergoing cervical spinal radiography. Methods: This was a prospective observational study of consecutive blunt trauma victims presenting to an urban Level 1 regional trauma center between April 1, 1998, and September 30, 1998. Prior to cervical spinal radiography, treating physicians evaluated each patient to determine whether a DPI was present or absent and, if present, what type of injury was sustained. Injuries were categorized as fractures, soft‐tissue injuries and lacerations, burns, visceral injuries, crush injuries, or other injuries. Results: Data were collected for 778 patients, between 1 month and 98 years old, of whom 264 (34%) were considered to have DPIs. Physicians were unable to determine the DPI status in 47 (6%) additional cases. Fractures accounted for a majority of DPIs (154, or 58%), 42 (16%) were soft‐tissue injuries or lacerations, and 86 (34%) were due to a variety of other entities, including visceral, crush, burn, or other miscellaneous injuries. Among the 37 (5%) patients with an acute cervical spinal injury, 20 (54%) had a DPI, including three (8%) who had DPI as the only indication for cervical radiography. Conclusions: A significant number of blunt trauma patients are believed by clinicians to have DPIs that can possibly mask the presence of cervical spinal injury. Fractures and trauma to soft tissues are the most common types of DPI.