Blunt cervical spine injuries in Scotland 1995-2000.
BACKGROUND
In the Accident and Emergency Department, the management of patients who have sustained head injuries (HI) is often made more complicated by the suspicion of a cervical spine injury (CSI). This study aimed to evaluate the incidence of CSI in patients sustaining blunt head injuries in a Scottish population.


METHODS
Retrospective analysis of prospectively collected data for a 5-year period from the Scottish Trauma Audit Group (STAG) database. Logistic regression and other comparisons were used to investigate the relationship between Glasgow coma score/scale (GCS) and the incidence of CSI.


RESULTS
A total of 5154 patients met the criteria for the study and 273 of the HI patients had associated CSI giving an overall incidence of 5.3%. Patients presenting with GCS of 3 were almost three times more likely to have a CSI compared to patients with an initial GCS of 4 or more (12.5% versus 4.4%, chi(2)=62.9, d.f.=1, P<0.001). When patients with GCS of 3 were excluded, there was no evidence of an increase in the incidence of CSI with a lower GCS (logistic regression chi(2)=0.09, d.f.=1, P=0.75).


CONCLUSIONS
The risk of CSI in patients with blunt head trauma and an admission GCS of > or =4 does not decrease as GCS increases. Patients with blunt head injuries who present with a GCS of 3 are much more likely to have a concomitant CSI. The overall incidence of 5.3% compares with published series from other countries.
Drainer
Elaine K
EK
Department of Accident and Emergency Medicine, Southern General Hospital, 1345 Govan Road, Glasgow G51 4TF, UK. drainere@hotmail.com
Graham
Colin A
CA
Munro
Philip T
PT
D000293:Adolescent; D000328:Adult; D000368:Aged; D002574:Cervical Vertebrae / Q000293:injuries*; D005260:Female; D015600:Glasgow Coma Scale; D016489:Head Injuries, Closed / Q000453:epidemiology*; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012606:Scotland / Q000453:epidemiology; D014057:Tomography, X-Ray Computed / Q000379:methods; D014949:Wounds, Nonpenetrating / Q000453:epidemiology*