Frequency of intra-abdominal injury in cases of blunt trauma to the cervical spinal cord.
Historically, early management of the blunt trauma victim with hemodynamic instability and cervical spinal cord injury has been hampered by the physician's inability to perform an accurate physical examination. Invasive and time-consuming diagnostic tests are often run to check for the presence of occult intra-abdominal injuries. For this reason, we decided to study these patients by reviewing a clinical registry to assess the frequency of intra-abdominal injuries in cases of cervical spinal cord trauma. We hypothesized that intra-abdominal injury would occur infrequently in cases of blunt trauma to the cervical spinal cord. In fact, data from the Maryland Institute for Emergency Medical Services Systems revealed that blunt trauma victims with cervical cord injury rarely (2.6%) sustained intra-abdominal wounds. Further analysis of this population revealed that specific mechanisms of trauma and the presence of hemodynamic instability and other major injuries were factors strongly associated with occult intra-abdominal injury. In light of these findings, we have outlined a protocol for management of these patients that is geared toward more rapid stabilization of the injured spinal column.
Albuquerque
F
F
Division of Neurosurgery, University of Maryland School of Medicine, Baltimore.
Wolf
A
A
Dunham
C M
CM
Wagner
R
R
Spagnolia
T
T
Rigamonti
D
D
D000007:Abdominal Injuries / Q000150:complications / Q000175:diagnosis / Q000453:epidemiology*; D000293:Adolescent; D000328:Adult; D000368:Aged; D000465:Algorithms; D002985:Clinical Protocols; D003937:Diagnosis, Differential; D005260:Female; D006470:Hemorrhage / Q000150:complications; D006801:Humans; D008297:Male; D008396:Maryland / Q000453:epidemiology; D008875:Middle Aged; D009104:Multiple Trauma / Q000453:epidemiology*; D010529:Peritoneal Cavity; D012042:Registries; D012189:Retrospective Studies; D012769:Shock / Q000209:etiology / Q000503:physiopathology; D013119:Spinal Cord Injuries / Q000453:epidemiology* / Q000628:therapy; D013564:Sympathetic Nervous System / Q000293:injuries; D007507:Therapeutic Irrigation; D014949:Wounds, Nonpenetrating / Q000453:epidemiology*