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Clinical Guidelines for Delayed or Prolonged Transport*: III. Spine Injury

Published online by Cambridge University Press:  28 June 2012

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Extract

Conventional emergency medical services (EMS) guidelines recommend that essentially every victim of any significant trauma be treated in the field as having an unstable spine injury. For example, any victim of any motor vehicle crash generally is assumed to have an unstable spine injury and is transported to the hospital in full-spine immobilization. This approach generally is reasonable and appropriate for the conventional EMS context of rapid transport, because patient symptoms and physical examination often are unreliable for the time period immediately following the event.

The specialized context of delayed or prolonged transport, however, requires a closer look at assessment criteria and treatment procedures for spine injury. Full-spine immobilization, if it is not required, can be unnecessarily difficult, impractical, impossible, and even dangerous during prolonged evacuation, especially in severe environments or when using improvized equipment. Prolonged transport also provides an opportunity to repeat patient surveys and to observe changes in the patient's condition over time.

Type
We Believe
Information
Prehospital and Disaster Medicine , Volume 8 , Issue 4 , December 1993 , pp. 369 - 371
Copyright
Copyright © World Association for Disaster and Emergency Medicine 1993

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Footnotes

*

This is a corrected version of the We Believe that was published in Vol.8, No. 2 of Prehospilal and Disaster Medicine. Definition number 4 has been corrected. We apologize for this error.

References

Bachulis, BL, Long, WB, Hynes, GD et al. : Clinical indications for cervical spine radiographs in the traumatized patient. Ann Surgery 1987;153:473–477.Google Scholar
Bressler, MJ, Rich, GH: Occult cervical spine fracture in an ambulatory patient. Ann Emerg Med 1982;11:440–442.CrossRefGoogle Scholar
Burgess, AR, Poka, A: Musculoskeletal trauma. Emerg Med Clin N Amer 1984;2:871–882.Google Scholar
Cadoux, CG, White, JD, Hedberg, MC: High- yield roentgenographic criteria for cervical spine injuries. Ann Emerg Med 1987;16:738–742.CrossRefGoogle ScholarPubMed
Chilton, J, Dagi, TF: Acute cervical spine injuries. Am J Emerg Med 1985;3:340–351.CrossRefGoogle Scholar
Dagi, TF: The exclusion of cervical spine injury. Am J Emerg Med 1988;6:312–313. EditorialCrossRefGoogle ScholarPubMed
Deutsch, DS: The evaluation and immediate care of the patient with spinal trauma. RI Med J 1980;63:265–269.Google ScholarPubMed
Fischer, RF: Cervical radiographic evaluation of alert patients following blunt trauma. Ann Emerg Med 1984;13:905–907.CrossRefGoogle ScholarPubMed
Herkowitz, HN, Roth man, RH: Subacute instability of the cervical spine. Spine 1986;9:348–357.CrossRefGoogle Scholar
Holdsworth, F: Fractures, dislocations, and fracture-dislocations of the spine. J Bone Joint Surg 1970;52A:1534–1551.CrossRefGoogle Scholar
Jaffe, DM, Binns, H, Redkowski, MA et al. : Developing a clinical algorithm for early management of cervical spine injury in child trauma victims. Ann Emerg Med 1987;16:270–276.CrossRefGoogle ScholarPubMed
Kaplan, D: Spine problems in emergency department patients: Does every patient need an X-ray? J Emerg Med 1985;2:257–263.CrossRefGoogle ScholarPubMed
Kassel, EE, Cooper, PW, Rubenstein, JD: Radiology of spinal trauma—practical experience in a trauma unit. J Can Assoc Radial 1983;34:189–203.Google Scholar
Knopp, RK: Evaluation of the cervical spine: Unresolved issues. Ann Emerg Med 1987;16:1–27. Editorial.CrossRefGoogle ScholarPubMed
Korres, DS, Katsaros, A, Pantazopoulos, T et al. : Double or multiple level fractures of the spine. Injury 1981;13:147–152.CrossRefGoogle ScholarPubMed
Lee, C, Rogers, LF, Woodring, JH et al. : Fractures of the craniovertebral junction associated with other fractures of the spine: Overlooked entity? AJNR 1984;5:775–781.Google ScholarPubMed
McArdle, CB, Wright, JW, Prevost, WJ et al. : MR imaging of the acutely injured patient with cervical traction. Radiology 1986;159:273–274.CrossRefGoogle ScholarPubMed
Mace, SE: Emergency evaluation of cervical spine injuries: CT versus plain radiographs. Ann Emerg Med 1985;14:973–975.CrossRefGoogle ScholarPubMed
Miller, MD, Gehweiler, JA, Martinez, S: Significant new observations on cervical spine trauma. Am J Roentgenol 1978;130:659–663.CrossRefGoogle ScholarPubMed
Montana, MA, Richardson, ML, Kilcoyne, RF et al. : CT of sacral injury. Radiology 1986:161:499–503.CrossRefGoogle ScholarPubMed
Ordog, GJ: Missed cervical spine fractures. Ann Emerg Med 1987;16:726–727. Letter to the editor.CrossRefGoogle Scholar
Perdue, P: Urgent priorities in severe trauma: Life-threatening head and spinal injuries. RN 1981;44:36–41, 102.Google ScholarPubMed
Podolsky, S, Baraff, LJ, Simon, RR et al. : Efficacy of cervical spine immobilization methods. J Trauma 1983;23:461–465.CrossRefGoogle ScholarPubMed
Ravichandran, G: Missed orthopaedic injuries in the resuscitation room. J Royal Coll Surg Edinb 1984;29:126. Letter to the editor.Google ScholarPubMed
Reid, DC, Henderson, R, Saboe, L et al. : Etiology and clinical course of missed spine fractures. J Trauma 1987;27:980–986.CrossRefGoogle ScholarPubMed
Ringingberg, BJ, Urdaneta, LF, Midthun, MA: Rational ordering of cervical spine radiographs following trauma. Ann Emerg Med 1988;17:792–812.CrossRefGoogle Scholar
Rosen, P: On the evaluation of the traumatized cervical spine. J Emerg Med 1985:3:409–410. Editorial.CrossRefGoogle ScholarPubMed
Scher, AT: Unrecognised fractures and dislocations of the cervical spine. Paraplegia 1981:19:25–30.Google Scholar
Shaffer, MA, Doris, PE: Limitation of the cross table lateral view in delecting cervical spine injuries: A retrospective analysis. Ann Emerg Med 1981;10:508–513.CrossRefGoogle Scholar
Slack, CM: The spine in sports. Compr Ther 1980;6:68–74.Google ScholarPubMed
Streitwiesser, DR, Knoop, R, Wales, LR et al. : Accuracy of standard radiographic views in detecting cervical spine fractures. Ann Emerg Med 1983;12:538–542.CrossRefGoogle Scholar
Sumachai, AP: Missed cervical spine fractures. Ann Emerg Med 1987;16:726–727.CrossRefGoogle Scholar
Suomalainen, O, Kettunen, K, Saari, T: Computed tomography of spinal and pelvic fractures. Ann Chir Gynaecol 1983;72:337–341.Google Scholar
Tator, CH, Ekong, CE, Rowed, DW et al. : Spinal injuries due to hockey. Can J Neurol Sci 1984;11:34–41.Google Scholar
Vines, FS: The significance of “occult” fractures of the cervical spine. Am J Roentgenol Redium Ther Nucl Med 1969;107:493–504.CrossRefGoogle ScholarPubMed
Wales, LR, Knoop, RK, Morishima, MS: Recommendations for evaluation of the acutely injured cervical spine: A clinical radiologic algorithm. Ann Emerg Med 1980:9:422–428.Google Scholar
Walter, J, Doris, PE, Shaffer, MA: Clinical presentation of patients with acute cervical spine injury. Ann Emergy Med 1984;13:512–515.Google Scholar
Webb, SB, Berzins, E, Wingardner, TS et al. : Spinal cord injury: Epidemiologic implications, costs and patterns of care in 85 patients. Arch Phys Med Rehabilitation 1979:60:335–340.Google Scholar
White, AA 3d, Panjabi, MM, Posner, I et al. : Spinal stability: Evaluation and treatment. Instr Course Lect 1981;30:457–483.Google Scholar
Woodring, JH, Lee, C, Jenkins, K: Spinal fractures in blunt chest trauma. J Trauma 1988;28:789–793.Google Scholar