By Jill Stein
CHICAGO -- October 14, 2009 -- Contrary to popular opinion, clinically significant cervical spine injuries (CSCSI) may occur in patients who have fallen less than 6 metres (20 feet), or 2 stories of a building, researchers reported here October 13 at the American College of Surgeons (ACS) 95th Annual Clinical Congress.
Wendy R. Greene, MD, Howard University Hospital, Washington, DC, and colleagues reviewed outcomes in 2,573 trauma patients who presented to their institution over a recent 24-month period.
The ACS Committee on Trauma Resources Manual provides mechanistic criteria for trauma centre field triage and activation, Dr. Greene explained. The mechanisms include falls, high-risk auto crash, motorcycle, pedestrian injuries, and assault. The rationale is that patients with these mechanisms are thought to be more likely to have a clinically significant injury and should be evaluated by the trauma team. The fall criterion for adult trauma team activation (TTA) is greater than 6 metres.
In this study, CSCSI were defined as fractures and subluxations as opposed to a cervical strain.
Of patients with cervical spine pathology, 66 (56%) had CSCSI and 53 (44%) had strains.
Analysis of patients with CSCSI versus strain for all mechanisms of injury showed that patients aged older than 50 years were more likely to have a CSCSI while those aged younger than 50 years were more likely to have a strain.
In 26 patients with fall injuries, the height of fall had been documented. Of patients who had fallen from a height that exceeded 6 metres, the injury severity score (ISS) was less than 15 in 3 (75%) versus 1 (25%) with ISS greater than 15. Of patients who had fallen from less than 6 metres, 19 (86%) had an ISS less than 15 compared to 3 (14%) with ISS greater than 15.
In patients with fall as the mechanism of injury, CSCSI values were not statistically significant based on height or age when the fall height was less than 6 metres.
Dr. Greene said that a prospective study is needed to determine if the current TTA guidelines should be expanded to include patients who have fallen from less than 6 metres.
[Presentation title: Clinically significant Cervical Spine Injuries Can Occur With Falls Less Than 20 Feet. Abstract SE-188T]
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