Abstract
Objectives: Some trauma patients have an undiagnosed cervical spine injury but require immediate airway control. This paper reports an emergency department's (ED) experience with these patients. In particular, is there a worse neurological outcome?
Methods: A retrospective study over 6.5 years, based on prospectively collected data from the Royal Perth Hospital trauma registry. Patients with a cervical spine injury were identified and clinical data were abstracted. The primary outcome measure was evidence of exacerbation of cervical spine injury as a result of intubation by ED medical staff.
Results: 308 patients (1.9%) of the 15 747 trauma patients were intubated by ED medical staff. Thirty seven (12%) were subsequently verified to have a cervical spine injury, of which 36 were managed with orotracheal intubation. Twenty five (69%) survived to have a meaningful post-intubation neurological examination. Fourteen (56%) of these 25 patients had an unstable cervical spine injury. Ninety per cent of all ED intubations were by ED medical staff. No worsening of neurological outcomes occurred.
Conclusions: Every ninth trauma patient that this ED intubates has a cervical spine injury. Intubation by ED medical staff did not worsen neurological outcome. In the controlled setting of an ED staffed by senior practitioners, patients with undiagnosed cervical spine injury can be safely intubated.
Full Text
The Full Text of this article is available as a PDF (162.8 KB).
Selected References
These references are in PubMed. This may not be the complete list of references from this article.
- Banit D. M., Grau G., Fisher J. R. Evaluation of the acute cervical spine: a management algorithm. J Trauma. 2000 Sep;49(3):450–456. doi: 10.1097/00005373-200009000-00011. [DOI] [PubMed] [Google Scholar]
- Bohlman H. H. Acute fractures and dislocations of the cervical spine. An analysis of three hundred hospitalized patients and review of the literature. J Bone Joint Surg Am. 1979 Dec;61(8):1119–1142. [PubMed] [Google Scholar]
- Criswell J. C., Parr M. J., Nolan J. P. Emergency airway management in patients with cervical spine injuries. Anaesthesia. 1994 Oct;49(10):900–903. doi: 10.1111/j.1365-2044.1994.tb04271.x. [DOI] [PubMed] [Google Scholar]
- Crosby E. T., Lui A. The adult cervical spine: implications for airway management. Can J Anaesth. 1990 Jan;37(1):77–93. doi: 10.1007/BF03007488. [DOI] [PubMed] [Google Scholar]
- Davidson J. S., Birdsell D. C. Cervical spine injury in patients with facial skeletal trauma. J Trauma. 1989 Sep;29(9):1276–1278. doi: 10.1097/00005373-198909000-00016. [DOI] [PubMed] [Google Scholar]
- Goldberg W., Mueller C., Panacek E., Tigges S., Hoffman J. R., Mower W. R., NEXUS Group Distribution and patterns of blunt traumatic cervical spine injury. Ann Emerg Med. 2001 Jul;38(1):17–21. doi: 10.1067/mem.2001.116150. [DOI] [PubMed] [Google Scholar]
- Hastings R. H., Kelley S. D. Neurologic deterioration associated with airway management in a cervical spine-injured patient. Anesthesiology. 1993 Mar;78(3):580–583. doi: 10.1097/00000542-199303000-00022. [DOI] [PubMed] [Google Scholar]
- Hastings R. H., Marks J. D. Airway management for trauma patients with potential cervical spine injuries. Anesth Analg. 1991 Oct;73(4):471–482. doi: 10.1213/00000539-199110000-00019. [DOI] [PubMed] [Google Scholar]
- Hills M. W., Deane S. A. Head injury and facial injury: is there an increased risk of cervical spine injury? J Trauma. 1993 Apr;34(4):549–554. [PubMed] [Google Scholar]
- Hoffman J. R., Wolfson A. B., Todd K., Mower W. R. Selective cervical spine radiography in blunt trauma: methodology of the National Emergency X-Radiography Utilization Study (NEXUS). Ann Emerg Med. 1998 Oct;32(4):461–469. doi: 10.1016/s0196-0644(98)70176-3. [DOI] [PubMed] [Google Scholar]
- Holley J., Jorden R. Airway management in patients with unstable cervical spine fractures. Ann Emerg Med. 1989 Nov;18(11):1237–1239. doi: 10.1016/s0196-0644(89)80067-8. [DOI] [PubMed] [Google Scholar]
- Meschino A., Devitt J. H., Koch J. P., Szalai J. P., Schwartz M. L. The safety of awake tracheal intubation in cervical spine injury. Can J Anaesth. 1992 Feb;39(2):114–117. doi: 10.1007/BF03008639. [DOI] [PubMed] [Google Scholar]
- Muckart D. J., Bhagwanjee S., van der Merwe R. Spinal cord injury as a result of endotracheal intubation in patients with undiagnosed cervical spine fractures. Anesthesiology. 1997 Aug;87(2):418–420. doi: 10.1097/00000542-199708000-00029. [DOI] [PubMed] [Google Scholar]
- Neifeld G. L., Keene J. G., Hevesy G., Leikin J., Proust A., Thisted R. A. Cervical injury in head trauma. J Emerg Med. 1988 May-Jun;6(3):203–207. doi: 10.1016/0736-4679(88)90327-7. [DOI] [PubMed] [Google Scholar]
- ROGERS W. A. Fractures and dislocations of the cervical spine; an end-result study. J Bone Joint Surg Am. 1957 Apr;39-A(2):341–376. [PubMed] [Google Scholar]
- Reid D. C., Henderson R., Saboe L., Miller J. D. Etiology and clinical course of missed spine fractures. J Trauma. 1987 Sep;27(9):980–986. doi: 10.1097/00005373-198709000-00005. [DOI] [PubMed] [Google Scholar]
- Rhee K. J., Green W., Holcroft J. W., Mangili J. A. Oral intubation in the multiply injured patient: the risk of exacerbating spinal cord damage. Ann Emerg Med. 1990 May;19(5):511–514. doi: 10.1016/s0196-0644(05)82179-1. [DOI] [PubMed] [Google Scholar]
- Roth B. J., Martin R. R., Foley K., Barcia P. J., Kennedy P. Roentgenographic evaluation of the cervical spine. A selective approach. Arch Surg. 1994 Jun;129(6):643–645. doi: 10.1001/archsurg.1994.01420300087015. [DOI] [PubMed] [Google Scholar]
- Scannell G., Waxman K., Tominaga G., Barker S., Annas C. Orotracheal intubation in trauma patients with cervical fractures. Arch Surg. 1993 Aug;128(8):903–906. doi: 10.1001/archsurg.1993.01420200077014. [DOI] [PubMed] [Google Scholar]
- Sinclair D., Schwartz M., Gruss J., McLellan B. A retrospective review of the relationship between facial fractures, head injuries, and cervical spine injuries. J Emerg Med. 1988 Mar-Apr;6(2):109–112. doi: 10.1016/0736-4679(88)90148-5. [DOI] [PubMed] [Google Scholar]