Cervical spine injury: analysis and comparison of patients by mode of transportation.
BACKGROUND
Cervical spine injury (CSI) studies have identified different factors contributing to CSI, but none compares the incidence and pattern of injury of patients arriving at the Emergency Department (ED) by private vehicle (PV).


OBJECTIVE
We compared the characteristics and injury patterns in CSI patients who were transported to the ED via Emergency Medical Services (EMS) versus PV.


METHODS
We conducted a three-hospital retrospective review of patients with CSI from January 1, 2000 to December 31, 2007. We excluded transfers and follow-up visits. Using a standardized data collection form, we reviewed demographics, mode of transport, mechanism of injury, imaging results, injury type and level, and neurologic deficits. Means and proportions were compared using t-tests and chi-squared as appropriate.


RESULTS
Of 1174 charts identified, 718 met all study criteria; 671 arrived by EMS and 47 by PV. There was no difference between groups in age or gender. Ground-level fall was more likely in PV patients (32%, 95% confidence interval [CI] 20-46% vs. 6%, 95% CI 4-9%), whereas motor vehicle collision was less likely (32%, 95% CI 20-46% vs. 67%, 95% CI 63-70%). PV patients more often sustained a stable injury (66%, 95% CI 52-78% vs. 40%, 95% CI 36-44%), and were more often triaged to a lower-acuity area (25%, 95% CI 15-40% vs. 4%, 95% CI 3-6%). The incidence of neurologic deficit was similar (32%, 95% CI 20-46% vs. 24%, 95% CI 21-28%), though more PV patients had spinal cord injury without radiographic abnormality (21%, 95% CI 12-35% vs. 5%, 95% CI 4-7%).


CONCLUSIONS
A small proportion of patients with CSI present to the ED by PV. Although most had stable injuries, a surprising number had unstable injuries with neurologic deficits, and were triaged to lower-acuity areas in the ED.
UCSF-Fresno Medical Education Program, Fresno, CA 93701-2302, USA.
Alfredo E
AE
Urdaneta
Geoff
G
Stroh
James
J
Teng
Brandy
B
Snowden
Tyler W
TW
Barrett
Gregory W
GW
Hendey
D000058:Accidental Falls / Q000706:statistics & numerical data; D000063:Accidents, Traffic / Q000706:statistics & numerical data; D000328:Adult; D001265:Athletic Injuries / Q000453:epidemiology; D002140:California; D002574:Cervical Vertebrae / Q000293:injuries*; D004632:Emergency Medical Services; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D010264:Paraplegia / Q000453:epidemiology; D011782:Quadriplegia / Q000453:epidemiology; D012189:Retrospective Studies; D014187:Transportation of Patients / Q000379:methods*; D014218:Triage / Q000145:classification