Original ContributionsDistribution and patterns of blunt traumatic cervical spine injury*,**,*
Introduction
Injuries to the cervical spine occur in only 2% to 3% of all patients with blunt trauma but are significant because of their high level of associated mortality and morbidity.1, 2 Previous reports regarding the epidemiology of cervical spine injury have typically been based on review of inpatient records of trauma victims admitted to single institutions or special populations.3, 4, 5, 6, 7, 8 Data from these sources typically reflect the spectrum of injuries seen in large referral centers but do not provide reliable information on the overall characteristics of cervical spine injury.
To date, there have been no reliable investigations of the spectrum and distribution of cervical spine injuries. The purpose of this study is to examine cervical spine injury patterns by using prospective representative methodology and to determine the incidence, spectrum, and distribution of these injuries.
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Materials and methods
We performed a secondary analysis of the National Emergency X-Radiography Utilization Study (NEXUS) relational database. A detailed description of this study and its methodology are included elsewhere, including a separate report in this issue.9, 10 Briefly, NEXUS was a prospective, observational study performed with institutional review board approval at 21 diverse emergency departments in the United States. The study included all patients with blunt trauma who underwent cervical spine
Results
Of 34,069 enrolled patients, 818 (2.4%) had a radiographic cervical spine injury. These patients sustained 1,195 fractures and 231 subluxations or dislocations. The distribution of fractures is listed in Table 1.Spine Level No. of Fractures % of All Fractures Occipital condyle 20 1.67 C1 105 8.79 C2 (nonodontoid) 194 16.23 Odontoid 92 7.70 C3 51 4.27 C4 84 7.03 C5 179 14.98 C6 242 20.25 C7 228 19.08 Total 1,195 100.00
Discussion
Previous studies of cervical spine injury have been limited by the methods used to identify patients. Studies completed on the basis of chart review from a single institution,3 hospitalized patients,3, 4 or the elderly7, 11, 12, 13 all contain selection biases that limit their external validity and make it difficult to generalize results to larger populations.14 In contrast, the prospective data collected in the current study come from a diverse group of institutions and contain data on all
Acknowledgements
Author contributions: WG, CM, EAP, ST, JRH, and WRM participated in the project development, data collection, interpretation, authorship, and critical review. WG and WRM take responsibility for the paper as a whole.
We thank Guy Merchant, NEXUS Project Coordinator, for his outstanding contributions to the project, as well as the house officers and attending physicians at each of the participating NEXUS sites, without whose cooperation and hard work the study would not have been possible.
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Author contributions are provided at the end of this article.
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Supported by grant No. RO1 HS08239 from the Agency for Healthcare Research and Quality,formerly the Agency for Health Care Policy and Research.
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Address for reprints: William L. Goldberg, MD, Department of Emergency Medicine, Bellevue Hospital Center, First Avenue at 27th Street, New York, NY 10016;,212-562-7356; E-mail [email protected].