Blunt Cervical Spine Trauma and Distracting Injuries

Evaluation of the cervical spine (c-spine) is a key part of the initial evaluation of trauma patients in the emergency department. Although multiple guidelines have been presented in the literature to assist the emergency physician in determining whether imaging is needed in the assessment of the cervical spine, there is continued controversy on this subject. This study aimed to clarify the role of distracting injuries in the evaluation of cervical spine injuries. The authors collected prospective data on over 9000 blunt trauma patients admitted to the trauma surgery service at an academic medical center. Of these patients, 119 (1.3%) had a cervical spine injury, either bony or ligamentous, found on imaging, but 15% of these patients were excluded from the study because their physical examination was limited by intoxication or altered mental status. Of the 101 evaluable patients with confirmed c-spine injury, 96% (all but 4 patients) had midline neck pain or tenderness during their initial physical examination. These included 88 patients with injuries that have previously been described as “distracting,” including pelvic fractures and long bone fractures. The one finding that the authors found in common among the 4 patients with c-spine injuries but negative physical examination was bruising and tenderness of the upper anterior chest (with or without rib fracture). Based on these findings, the authors argued that current practice guidelines might result in overuse of c-spine imaging, and that a narrower definition of “distracting injuries” should be developed.