Cervical injuries in Sweden,a national survey of patient data from 1987 to 1999

Neck injuries are one of the most important injuries as they have the potential to influence the spinal cord. Data from most parts of the world are not sufficient to define a comprehensive view of mortality, morbidity, disability and handicap due to neck injuries. In Sweden, there are no data on the incidence of neck injuries. The aim of this study is to define the national incidence and causes of neck injuries in Sweden. An incidence study was undertaken with data from the injury surveillance program at the Swedish National Board of Health and Welfare. The investigation includes cervical vertebral fractures reported between 1987 and 1999, and cervical soft tissue injuries over a period of three years, from 1997 to 1999. Data between 1987 and 1996 were reported in ICD 9, while data from 1997 to 1999 were reported in ICD 10. During the study period, 14,310 non-fatal and 782 fatal cervical injuries occurred. A decreasing incidence for cervical fractures can be seen for the Swedish population, except for the elderly that have a slight increase in incidence. The incidence for cervical soft tissue injuries is almost constant. Cervical fractures demand longer periods of hospitalization than the soft tissue injuries. Transportation-related cervical fractures have dropped since 1991, while soft tissue injuries increased slowly between 1997 and 1999. Fall accidents are now the largest external cause of cervical fractures, and the population above 65 years accounts for almost 50% of the fall accidents. The male population has a higher incidence of cervical fractures, disregarding age. It is concluded that safety programs for transportation-related injuries in Sweden have been successful, while fall accidents are still substantial. Much more can be done to prevent neck injuries; especially to reduce the number of transportation-related cervical soft tissue injuries and fall injuries in the elderly population.     

Injuries from motorcycle- and moped crashes in Sweden from 1987 to 1999

The objective of this paper is to study injuries from motorcycle and moped crashes in Sweden from 1987 to 1999. Databases at the National Board for Health and Welfare and codes from both ICD9 and ICD10 systems were used, including patterns of age, gender, E-code and type of injury. Length of hospital stay, type of injuries and trends over time was evaluated. To get a more detailed picture of the age distribution, type of vehicle used and number of killed, data from the Swedish National Road Administration were also used. In Sweden, 27,122 individuals received in-patient care due to motorcycle and moped injuries between 1987 and 1999. The motorcycle and moped injury rate was reduced in the second half of the studied period and so were the total days of treatment per year. Males had eight times the incidence of injuries compared to females. Riders under the age of 26 and in particular those at an age of 15 had the highest incidence rate. Head injuries were the most frequent diagnosis, followed by fractures to the lower limbs. Concussion was the most frequent head injury. Focal and diffuse brain injuries combined showed the same frequency as concussion. It is concluded that more preventative strategies must be presented before the injury rate can be reduced.     

Increase in the incidence of cervical and trochanteric fractures of the proximal femur in Niigata Prefecture, Japan

This study aimed to determine the incidence of cervical and trochanteric fractures of the proximal femur in 1994 in Niigata Prefecture, Japan, and to compare this incidence with those previously reported in Niigata in 1985, 1987, and 1989. We visited all hospitals within Niigata Prefecture having an orthopedic department and reviewed the medical records and radiographs of all patients who sustained such fractures in 1994. The population of Niigata Prefecture was determined in 1994 to be 2 483 879 (1 205 151 males and 1 278 728 females). The population over 65 years of age was 428 795 (172 788 males and 256 007 females), representing 17.3% of the total population. In 1994, there were 1468 cervical or trochanteric fractures in 378 males and 1090 females, with a male-to-female ratio of 1 : 2.9. The incidence of these fractures in persons over 65 years of age was 304 fractures per 100 000 population per year. Of 528 cervical and 940 trochanteric fractures, the latter accounted for 64% of the total number. The age-specific incidence of the fractures in Niigata exhibited an exponential increase with age, similar to those reported in Sweden and the United States. However, the incidence was lower than in those countries. When comparing the number of cervical and trochanteric fractures in 1994 with the numbers reported in 1985, 1987, and 1989, it is evident that the overall number and incidence of these fractures has been increasing over this period. Even if the difference of the age-specific population among these years is adjusted, the fractures have been increasing. Received: Dec. 27, 1996 / Accepted: Jan. 14, 1999     

A review of serious injury and death from gunshot wounds in Sweden: 1987 to 1994.

OBJECTIVE: To evaluate the incidence, range and causes of injury, medical consequences, and mortality of patients with gunshot wounds (GSW) in Sweden. DESIGN: Retrospective case study. SETTING: The Swedish Hospital National Discharge Register (SNHDR). SUBJECTS: 1559 patients with gunshot wounds, in all 2394 episodes treated in Swedish hospitals from 1987-1994. INTERVENTIONS: Statistical analysis of the Register. MAIN OUTCOME MEASURES: Incidence of GSW in Sweden, mortality, range of injuries and medical consequences. RESULTS: From 1987 to 1994 a total of 1559 people were admitted to Swedish hospitals with GSW, which corresponds to 2.3 injuries/100000 population/year. In all, 2394 episodes were treated in hospitals. There were 1373 men (88%) and 186 women (12%), with a median age of 29 years (range 1-92). Of these, 990 were recorded as accidents (63%), 257 as suicides (16%), 174 as attempted murder (11%), and 138 as of "unknown cause" (9%). The annual incidence of GSW in Sweden was relatively constant during this period. The total number of deaths in our series of patients was 111 (7%), including 74 suicides, 16 accidents, 14 homicides, and 7 of "unknown cause". Among these, 53% had a head injury, 11% thoracic, and 8% abdominal injuries. Compared with other countries in the world, the incidence of GSW in Sweden is comparable with New Zealand and Finland, but lower than in the USA. Injuries to extremities were most common, followed by injuries to the head and neck. Thirty percent of all those admitted to hospital required more than one week in hospital. CONCLUSIONS: The incidence of GSW is low in Sweden, and they are mainly caused by accidents or attempted suicide. Injuries to the extremities were most common, followed by injuries to the head and neck. Two thirds of the patients left hospital within a week. Seven percent of patients treated for GSW in hospital died.     

Spinal injury in major trauma: Epidemiology of 1104 cases from an Italian first level trauma center

IntroductionTraumatic spinal injuries are frequent and their management is debated, especially in major trauma patients. This study aims to describe a large population of major trauma patients with vertebral fractures to improve prevention measures and fracture management.Patients and methodsRetrospective analysis of 6274 trauma patients prospectively collected between October 2010 and October 2020. Collected data include demographics, mechanism of trauma, type of imaging, fracture morphology, associated injuries, injury severity score (ISS), survival, and death timing. The statistical analysis focused on mechanism of trauma and the search of predictive factors for critical fractures.ResultsPatients showed a mean age of 47 years and 72.5% were males. Trauma included 59.9% of road accidents and 35.1% of falls. 30.7% patients had at least a severe fracture, while 17.2% had fractures in multiple spinal regions. 13.7% fractures were complicated by spinal cord injury (SCI). The mean ISS of the total population was 26.4 (SD 16.3), with 70.7% patients having an ISS≥16. There is a higher rate of severe fractures in fall cases (40.1%) compared to RA (21.9% to 26.3%). The probability of a severe fracture increased by 164% in the case of fall and by 77% in presence of AIS≥3 associated injury of head/neck while reduced by 34% in presence of extremities associated injuries. Multiple level injuries increased with ISS rise and in the case of extremities associated injuries. The probability of a severe upper cervical fracture increased by 5.95 times in the presence of facial associated injuries. The mean length of stay was 24.7 days and 9.6% of patients died.ConclusionsIn Italy, road accidents are still the most frequent trauma mechanism and cause more cervico-thoracic fractures, while falls cause more lumbar fractures. Spinal cord injuries represent an indicator of more severe trauma. In motorcyclists or fallers/jumpers, there is a higher risk of severe fractures. When a spinal injury is diagnosed, the probability of a second vertebral fracture is consistent. These data could help the decisional workflow in the management of major trauma patients with vertebral injury.     

Pedestrians who required admission to hospital after collisions with motor vehicles in Sweden from 1987 to 1994.

OBJECTIVES: To report the incidence, range of injury, medical consequences, and mortality of pedestrians in collisions with motor vehicles in Sweden. DESIGN: Retrospective case study. SETTING: The Swedish Hospital Discharge Register (SHDR). SUBJECTS: 8684 pedestrians in collisions with motor vehicles had a total of 12,036 episodes treated in Swedish hospitals from 1987-1994. INTERVENTIONS: Statistical analysis of the Register. MAIN OUTCOME MEASURES: Incidence of pedestrians in collisions with motor vehicles in Sweden, mortality, range of injuries, and medical consequences. RESULTS: From 1987 to the end of 1994, a total of 8684 pedestrians were admitted to Swedish hospitals after collisions with motor vehicles. A mean of 17.6 persons were admitted/100,000 population/year. In all there were 12,036 admissions of injured pedestrians. There were 4593 men (53%) and 4091 women (47%), with a median age of 47 (range 1-100) years. The annual incidence of injured pedestrians (both men and women) decreased significantly during this period. Injuries to the extremities were commonest (39% fractures), followed by injuries to the head and neck (34%). The total number of deaths in our series of patients was 444 (5%). Of these, more than half had head injuries, 22% had fractures, and 5% abdominal or thoracic injuries. CONCLUSION: The number of pedestrians in collisions with motor vehicles is low in Sweden. Injuries to the extremities were commonest, followed by injuries to the head and neck. Old people were most likely to be injured and 5% of the patients treated in hospital died.     

The epidemiology of head injuries in Sweden from 1987 to 2000

The purpose of the present study was to evaluate the variability in the annual head injury incidence rate in Sweden from 1987 to 2000. It was hypothesized that the annual incidence rate would decrease over time due to a variety of primary preventive strategies that have been introduced in Swedish society. We used the Hospital Discharge Register at the National Board for Health and Welfare and head injury codes 800-804, and 850-854 from ICD9 system and S2.0-S2.9, and S6.0-S6.9 codes from ICD-10 system. We evaluated the patterns of age, gender, external cause of injury (E-code), type of injury, length of hospital stay, and trends over time. Head injuries due to transportation collision were reduced over the 14-year period analysis. Falls persisted as the dominant cause of head injury. Overall, men had 2.1 times the incidence of head injury compared to women. There was a decline in younger ages experiencing a head injury over this interval, while the number of head injuries among elderly people increased over time. Concussion was about three times more frequent than fractures. Hematoma and diffuse or focal contusions had a much lower incidence rate than concussion. Concussions and fractures decreased over time. Diffuse or focal injuries showed a steady rate of occurrence over the study interval while hematoma increased. Although length of hospital stay varied widely from zero to more than 50 days, 73.6% of hospital days were confined to two days or less. The incidence rate is stable over this time frame. While head injuries attributable to transportation accidents decreased, falls made up an increasing proportion of head injuries. Since we observed an increase in head injuries among elderly, primary prevention strategies may need to be targeted at this age group, and at preventing falls.     

Cervical spine fracture patterns predictive of blunt vertebral artery injury

BACKGROUND: Aggressive screening for blunt cerebrovascular injury (BCVI) has uncovered an astonishing incidence of vertebral artery injuries (VAIs) and associated stroke rate. Stroke incidence is reduced with early recognition and prompt anticoagulation. Because of the proximity of the cervical spine and vertebral arteries, we queried whether all patients with cervical spine fractures required arteriography to rule out VAI. METHODS: Four-vessel cerebrovascular angiography remains the standard screening test for patients at risk for BCVI. Patients undergoing angiographic screening for blunt cerebrovascular injuries have been prospectively followed at our regional trauma center since January 1990; however, in January 1996, we began aggressive screening based on injury patterns. RESULTS: Ninety-two patients with vertebral artery injuries were identified during the study period from January 1996 to June 2002. Two patients with vertebral injuries had minor cervical fractures, a C6 body fracture and a C7 spinous process/laminar fracture; both underwent diagnostic angiography for injury mechanism. Of the 21 patients without cervical spine fracture, angiographic screening for BCVI was performed for neurologic symptoms (11 patients), basilar skull fracture (6 patients), or severe facial fractures (4 patients). Cervical spine fracture was the sole indication for VAI in 69 patients. The fracture patterns were subluxations in 38 patients (55%) or extension of the fracture through the foramen transversarium in 18 patients (26%). The remaining injuries (18%) were located in the upper cervical spine: isolated C1 arch in eight patients and C2/3 body fractures in five patients. CONCLUSION: Blunt vertebral artery injury is associated with complex cervical spine fractures involving subluxation, extension into the foramen transversarium, or upper C1 to C3 fractures. Routine screening should incorporate these findings to maximize yield while limiting the use of invasive procedures.     

Mortality pattern according to autopsy findings among traffic accident victims in Yazd, Iran

Objective： To describe mortality pattern and to determine undiagnosed fatal injuries according to autopsy findings among road traffic accident victims in Yazd, Iran.
Methods： In this retrospective study, 251 victims of road traffic accidents who were admitted to a tertiary trauma hospital over a two-year period （2006 and 2007） and received medical cares were included. Hospital records were reviewed to gather demographic characteristics, road user type, and medical data. Autopsy records were also reviewed to determine actual causes of death and possible undiagnosed injuries occurred in the initial assessment of the emergency unit or during hospitalization.
Results： There were 202 males （80.5%） and 49 females （19.5%）. The mean （＋SD） age of fatalities was 34.1 （＋21.5） years. Pedestrian-vehicle accidents were the most common cause of trauma （100 cases, 39.8%）. The most common cause of death was central nervous system injury （146 cases, 58.1%）. The other causes were skull base fractures （10%）, internalbleeding （8%）, lower limb hemorrhage （8%）, skull vault fractures （4%）, cervical spinal cord injury （3.6%）, airway compromise （3.2%）, and multifactor cases （5.1%）, respectively. Thirty-six fatal injuries in 30 victims （12%） mainly contributed to death according to autopsy, but were not diagnosed in initial assessments. The head （72.2%） and cervical spine （13.8%） regions were the two most common sites for undi- agnosed injuries.
Conclusion： Training courses for emergency unit medical staff with regard to interpreting radiological findings of head and neck and high clinical suspicion for cervical spine injuries are essential to improve the quality of early hospital care and reduce the mortality and morbidity of traffic accident patients.     

Skeletal fracture demographics in spinal cord-injured patients

Introduction The demographics of skeletal fractures found in patients presenting with a spinal cord injury to a modern level-one trauma center have not been reported.Materials and methods A retrospective review was performed of 1290 patients presenting between January 1997 and December 1999 with an acute vertebral fracture and spinal cord or cauda equina injury to determine the incidence, fracture type, and mechanism of all fractures of the extremities and pelvis.Results Overall, 128 (10% of 1290) of these patients sustained 203 associated skeletal fractures including 16 open fractures (8% of 203). The most common associated fractures involved the radius, tibia, femur, humerus, fibula, and ulna. Some 48% of the injuries was due to motor vehicle accidents, 41% to falls, 6% to recreational injuries or assaults, and 5% to gunshot wounds. Twenty-four patients (1.8% of 1290) were found to have more than one vertebral fracture and sustained a high rate of associated fractures (42 fractures), averaging 1.8 fractures per patient. Conclusion This study underscores the frequent association between vertebral fractures and fractures of the appendicular skeleton and pelvis and reinforces the need to maintain a high index of suspicion when evaluating neurologically injured patients due to the potential for symptom masking of acute nonspinal fracture.     

胸椎骨折伴胸骨骨折9例分析

目的对胸椎骨折伴发胸骨骨折进行初步探讨与分析。方法自2001年11月至2006年l0月，共收治胸椎骨折伴胸骨骨折患者9例，全部病例行X线、CT及MRI检查。根据患者年龄、性别、受伤原因、胸骨骨折部位、胸椎损伤节段及类型、脊髓损伤程度及其他合并伤等资料均作为相关信息列入分析。结果损伤原因以交通伤和坠落伤为主，3例为多节段骨折，9例合并多发创伤或多发骨折。脊髓损伤发生率高，损伤程度严重。结论胸椎骨折伴胸骨骨折的临床特点为致伤暴力强大，脊柱骨折、脊髓损伤严重，合并多发伤发生率高。胸骨是胸廓环的重要组成结构，并在维持胸椎的稳定性中发挥着重要的作用。     

A review of serious injuries and deaths from bicycle accidents in Sweden from 1987 to 1994

BACKGROUND: Injured cyclists are often seen in emergency departments. The aims of this study were to determine the long-term incidence of injuries, age and gender distributions, mortality rates, and geographic differences among all patients admitted to hospitals because of bicycle accidents in Sweden. METHODS: Between 1987 and 1994, 34,606 persons (39,183 admissions) were injured in bicycle accidents in Sweden (19,978 men and 14,628 women). RESULTS: The annual frequency of hospital admissions ranged from 4,585 to 5,212. Fifty-seven patients were admitted with bicycle-related injuries per 100,000 population each year. Children between 5 and 14 years of age, especially boys, and men older than 70 were more commonly involved. Injuries to the head and brain were very frequent (46%). The survival rate was poorest in persons of older age, male gender, and cyclists involved in collisions with motor vehicles. CONCLUSION: About 4,900 cyclists have been hospitalized each year after bicycle accidents in Sweden. Young children were affected very often, with injuries of the brain and various types of fractures of the extremities being common. Significant factors for a poor survival outcome included old age, male gender, and collisions with motor vehicles.     

Trends in the incidence and severity of stab wounds in Sweden 1987-1994.

OBJECTIVE: To evaluate the incidence, types of injury, medical consequences, and mortality of patients with stab wounds in Sweden. DESIGN: Retrospective case study. SETTING: The Swedish National Hospital Discharge Register (SNHDR) and the Register of Causes of Death, Statistics Sweden (RCDSS) SUBJECTS: 1315 patients with stab wounds. All 1507 episodes were treated in Swedish hospitals from 1987-1994. MAIN OUTCOME MEASURES: Incidence of stab wounds in Sweden, mortality, types of injuries and medical consequences. RESULTS: From 1987 to 1994, 1315 people were admitted to Swedish hospitals with stab wounds, which corresponds to 2.1 injuries/100,000 population/year. In all, 1507 episodes were treated in hospital. There were 1121 men (85%) and 194 women (15%), with a median age of 32 years (range 1-88). The annual incidence was relatively constant during this period. The total number of deaths was 45/1315 (3.4%). Among these, 13 (29%) had thoracic, 9 (21%) abdominal, 7 (16%) head/neck and 7 (15%) extremity injuries. Twenty percent of those admitted to hospital had to spend more than one week there. CONCLUSIONS: The incidence of stab wounds was low and the annual incidence stable. Young men in urban areas were the commonest victims. Injuries of the trunk were commonest, followed by injuries to the head and neck and limbs, 80% of the patients were discharged from hospital within a week, and 3% of those treated in hospital for stab wounds died.     

The incidence of cervical and trochanteric fractures of the proximal femur in 1999 in Niigata Prefecture,Japan

 The purpose of this study was to determine the incidence of cervical and trochanteric fractures of the proximal femur in 1999 in Niigata Prefecture, Japan, and to compare this incidence with those previously reported in Niigata in 1985, 1987, 1989, and 1994. The authors visited all hospitals within Niigata Prefecture having an orthopedic department and reviewed the medical records and radiographs of all patients who sustained such fractures in 1999. The population of Niigata Prefecture was determined in 1999 to be 2 486 999 (1 208 195 males and 1 278 804 females). The population over 65 years of age was 515 290 (210 564 males and 304 726 females), representing 20.7% of the total population. In 1999, there were 1697 cervical or trochanteric fractures, in 400 males and 1297 females, with a male-to-female ratio of 1 : 3.2. The incidence of these fractures in persons over 65 years of age was 308.7 fractures per 100 000 per year. This incidence increased from 1985 to 1989 and from 1989 to 1994, but after that, the rate of increase in incidence from 1994 to 1999 slowed down slightly. This suggests that the prevention of fractures in the elderly population in Niigata Prefecture influenced the lower ratio. Received: December 28, 2001 / Accepted: February 28, 2002     

Prospective screening for blunt cerebrovascular injuries: analysis of diagnostic modalities and outcomes

OBJECTIVE: To prospectively examine outcomes associated with an aggressive screening protocol for blunt cerebrovascular injury (BCVI), and to compare the accuracy of computed tomographic angiography (CTA) and magnetic resonance angiography (MRA) versus conventional angiography with respect to BCVI diagnosis. SUMMARY BACKGROUND DATA: In the past 5 years, BCVI (carotid and vertebral arteries) has been recognized with increasing frequency. Initial studies described blunt carotid injuries and their associated morbidity, while more recent reports have established the devastating potential of blunt vertebral injuries. It has been suggested that early diagnosis and anticoagulation will improve outcomes and that less-invasive diagnostic techniques than conventional angiography are desirable for screening. However, there are neither established screening criteria nor studies comparing optimal diagnostic modalities. METHODS: The screened population included all patients with cervical spine fractures, LeFort II or III facial fractures, Horner's syndrome, skull base fractures involving the foramen lacerum, neck soft tissue injury, or neurological abnormalities unexplained by intracranial injuries. Patients underwent screening with four-vessel cerebral angiography. During the first half of the study, patients also underwent helical CTA. Selected patients during this same period underwent MRA. At the time of diagnosis, anticoagulant or antiplatelet therapy was instituted unless clinically contraindicated. Results of this screening protocol were compared to a previously published cohort with cerebrovascular injuries (1995-1999) from the authors' institution. RESULTS: Two hundred sixteen patients were screened over a 2-year period (3.5% of all blunt trauma admissions). Angiography identified 24 patients with carotid artery injuries (CAI) and 43 patients with vertebral artery injuries (VAI) for an overall screening yield of 29%. While the incidence of CAI remained similar between the current study and the previous study group, the incidence of VAI diagnosis increased. Stroke rates in those with CAI were also similar between the two periods. The stroke rate in VAI, however, was markedly lower at 0% as compared to 14% in the previous group. Comparison of CTA and MRA with cerebral angiography in 143 patients demonstrated sensitivities of 47% and 50%, respectively, for CAI; sensitivities were 53% (CTA) and 47% (MRA) for VAI. CONCLUSIONS: Aggressive screening of patients with blunt head and neck trauma identified an incidence of BCVI in 1.03% of blunt admissions. Early identification, which led to early treatment, significantly reduced stroke rates in patients with VAI, but provided no outcome improvement with CAI. More encompassing screening may be required to improve outcomes for patients with CAI. However, less-invasive diagnostic techniques (CTA and MRA) are inadequate for screening. Technological advances are necessary before abandonment of conventional angiography, which remains the standard for diagnosis.     

Delayed diagnosis of cervical spine injuries.

Over a 32-month period, the cases of all patients with multiple injuries on whom cervical spine roentgenograms (CSRs) were obtained during blunt trauma evaluation in a trauma center were reviewed to determine the incidence, outcome, and clinical consequence of delayed diagnosis of cervical spine injuries. A total of 1,331 patients had CSRs following blunt injury. Sixty-one (4.6%) of the patients had documented cervical fractures or dislocations. The patients were seriously injured (mean Trauma Score, 12; mean Glasgow Coma Scale score, 11; and mean Injury Severity Score, 30.3). Eleven of the patients died in the trauma room; 9 with fatal atlantoaxial dislocation. Of the 50 survivors (81.9%), neurologic deficits were present in 15 (30%), and 8 of those had complete spinal cord injuries. The diagnosis of the cervical spine injury was made during the initial evaluation in 56 of the 61 patients (91.8%). Five patients had delayed recognition of their cervical spine injury (2-21 days). The reason for the delay was incomplete CSRs in all patients, despite multiple views (up to 13). The missed injuries occurred in patients in whom complete visualization of the spine was most difficult (i.e., severe degenerative arthritis of the cervical spine in two patients; previous cervical fractures in one patient; instability during resuscitation in one patient). Radiologic misinterpretation occurred in one patient. The diagnosis of cervical spine injury was pursued because of persistent neck pain in two patients, and the development of subtle neurologic findings in three. The neurologic deficits in the three patients resolved.(ABSTRACT TRUNCATED AT 250 WORDS)     

Liberalized screening for blunt carotid and vertebral artery injuries is justified

BACKGROUND: Current literature suggests that blunt carotid injuries (BCIs) and vertebral artery injuries (BVIs) are more common than once appreciated. Screening criteria have been suggested, but only one previous study has attempted to identify factors that predict the presence of BCI/BVI. This current study was conducted for two reasons. First, we wanted to determine the incidence of BCI/BVI in our institution. Second, we wanted to determine the incidence of abnormal four-vessel cerebral angiograms ordered for injuries and signs believed to be associated with BCI/BVI and thus to determine whether the screening protocol developed was appropriate. METHODS: From August 1998, we used liberalized screening criteria for patients who were prospectively identified and suspected to be at high risk for BCI/BVI if any of the following were present: anisocoria, unexplained mono-/hemiparesis, unexplained neurologic exam, basilar skull fracture through or near the carotid canal, fracture through the foramen transversarium, cerebrovascular accident or transient ischemic attack, massive epistaxis, severe flexion or extension cervical spine fracture, massive facial fractures, or neck hematoma. Four-vessel cerebral angiograms were used for screening for BCI/BVI. RESULTS: Over the 18-month study period, 48 patients were angiographically screened, with 21 patients (44%) being identified as having a total of 19 BCIs and 10 BVIs. Nine patients had unilateral carotid artery injuries and three patients had bilateral carotid artery injuries. Vertebral artery injuries were unilateral in six patients. One patient had bilateral carotid artery injuries and a unilateral vertebral artery injury. One patient had a unilateral carotid artery injury and a unilateral vertebral artery injury, and one patient had a unilateral carotid artery injury and bilateral vertebral artery injuries. During the same study period, 2,331 trauma patients were admitted, with 1,941 (83%) secondary to blunt trauma. The overall incidence of BCI/BVI was 1.1%. The frequency of abnormal angiograms ordered for cerebrovascular accident or transient ischemic attack, massive epistaxis, or severe cervical spine fractures was 100%. The frequency of abnormal angiograms ordered for the other indications was as follows: fracture through foramen transversarium, 60%; unexplained mono- or hemiparesis, 44%; basilar skull fracture, 42%; unexplained neurologic examination, 38%; anisocoria, 33%; and severe facial fractures, 0%. CONCLUSION: The liberalized screening criteria used in this study were appropriate to identify patients with BCI/BVI. This study suggests BCI/BVI to be more common than previously believed and justifies that screening should be liberalized.     

Detection of cervical spine injuries in alert, asymptomatic geriatric blunt trauma patients: who benefits from radiologic imaging?

There are differing recommendations in the literature regarding cervical spine imaging in alert, asymptomatic geriatric patients. Previous studies also have not used computed tomography routinely. Given that cervical radiographs may miss up to 60 per cent of fractures, the incidence of cervical spine injuries in this population and its implications for clinical management are unclear. We conducted a retrospective study of blunt trauma patients 65 years and older who were alert, asymptomatic, hemodynamically stable, and had normal neurologic examinations. For inclusion, patients were required to have undergone computed tomography and plain radiographs. The presence and anatomic location of potentially distracting injuries or pain were recorded. Two hundred seventy-four patients were included, with a mean age of 76 +/- 10 years. The main mechanisms of injury were falls (51%) and motor vehicle crashes (41%). Nine of 274 (3%) patients had cervical spine injuries. The presence of potentially distracting injuries above the clavicles was associated with cervical injury when compared with patients with distracting injuries in other anatomic locations or no distracting injuries (8/115 vs 1/159, P = 0.03). There was no association of cervical spine injury with age greater or less than 75 years or with mechanism of injury. The overall incidence of cervical spine injury in the alert, asymptomatic geriatric population is low. The risk is increased with a potentially distracting injury above the clavicles. Patients with distracting injuries in other anatomic locations or no distracting injuries may not need routine cervical imaging.     

Spinal cord injuries due to diving accidents

STUDY DESIGN: Retrospective study and data analysis. OBJECTIVE: To investigate and analyse the main features of spinal cord injuries due to diving accidents accepted in our Centre from June 1978 to December 2002. SETTING: Regional Spinal Unit of Florence, Italy. INTRODUCTION: Diving accidents mostly occur in a young and healthy population and most of the patients develop tetraplegia with a severe lifelong disability. From 1978 to 2002, 65 patients with spinal injuries due to diving accidents were admitted to the Regional Spinal Unit of Florence. MATERIAL AND METHODS: A retrospective study was conducted by analysing data stored in our local computerized database. We considered the vertebral injury, ASIA-ISCOS neurological classification on admission and discharge, gender, age at the time of injury, month of injury, treatment of vertebral lesion, length of stay in the Spinal Unit, neurological outcome, and complications. Data were analysed statistically by using the Fisher's exact test and logistic regression. RESULTS: In all, 62/65 patients were males (95%). Mean age at injury time: 22 years. On admission, 35/65 were neurologically complete ASIA A (54%), while 16 were classified ASIA B, 7 ASIA C and 7 ASIA D, according to the ASIA-ISCOS neurological standard of classification. C6 was the most common neurological motor level (40%) and C5 the most common vertebral injury level. In all, 36/65 (55%) patients underwent surgical treatment. Mean hospitalization time was 5 months. No neurological deterioration was recorded. In all, 20/65 (31%) patients improved neurologically and 16/20 (80%) of those had received surgical treatment. In all, 15/65 (23%) patients had complications and one patient died during the hospitalization period. CONCLUSIONS AND DISCUSSION: Patients whose vertebral lesions were surgically treated had a better neurological outcome than conservatively treated ones. Teardrop fractures showed worse neurological outcome as compared with burst fractures. Neurological improvement was more present in initially incomplete lesions. Treatment with high dose methylprednisolone during the first 8 h after trauma seemed to influence the neurological outcome positively. Age was also an important factor in influencing the neurological outcome.     

Injuries in 8927 patients admitted after motor-cycle crashes in Sweden 1987-1994 inclusive.

OBJECTIVE: To discover morbidity and mortality rates after motor-cycle crashes on the national level in Sweden. DESIGN: Retrospective study. SETTING: Teaching hospital, Sweden. INTERVENTIONS: Extraction of data from International Classification of Diseases (ICD) codes E819C (motor-cycle drivers) and E819D (motor-cycle passengers) recorded in the Swedish Hospital Discharge Register (SHDR) between 1987 and 1994. MAIN OUTCOME MEASURES: Injury distribution, medical consequences, mortality, survival, and incidence by age, sex and geographical area. RESULTS: The number of people admitted to hospital after motor-cycle crashes decreased significantly during the period (from 1743 in 1987 to 1258 in 1994, p < 0.001). The most frequent injuries among drivers and passengers alike were fractures of the legs, arms, and vertebrae, followed by injuries to the head and brain. The in-hospital mortality was lower among drivers (n = 172, 2.2%) than among passengers (n = 31,3.3%). CONCLUSION: The incidence of injuries after motor-cyclist crashes decreased during the study period. The most common victims were young men with fractures and brain injuries. Those at most risk of dying were older passengers.