title: Clearing the Cervical Spine in a War Zone: What Other Injuries Matter?
abstract: BACKGROUND
  Cervical spine clearance requires clinicians to assess the reliability of physical examination based on a patient's mental status and distracting injuries. Distracting injuries have never been clearly defined in military casualties.
  
  
  METHODS
  Retrospective review was conducted of patients entered into Department of Defense Trauma Registry January 2008 to August 2013, identifying blunt trauma patients with cervical spine injury and Glasgow Coma Score ≥ 14. Physical examination and radiology results were abstracted from medical records and injury diagnoses were obtained from Department of Defense Trauma Registry. Groups were compared, p-value of < 0.05 was considered significant.
  
  
  RESULTS
  A total of 149 patients met study criteria; 20 patients (13%) had a negative clinical examination of the cervical spine. Coexisting injuries identified in patients with negative physical examination included injuries in proximity to the neck (head, thoracic spine, chest, or humerus) in 17 (85%) patients. In 3 patients (15%), coexisting injuries were not in proximity to the neck and included pelvic, femur, and tibia fractures. All patients without coexisting injury (n = 37) had a positive physical examination.
  
  
  CONCLUSIONS
  Physical examination of multitrauma casualties with neck injury may be unreliable when distracting injuries are present. When no distracting injuries were present, the physical examination was accurate in all patients.
authors.affiliation: Health Services Group Headquarters, Canadian Forces Base Edmonton, PO Box 10500 Station Forces, Edmonton, Alberta, Canada T5J 4J5.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Drew
authors.affiliation: Center for the Sustainment of Trauma and Readiness Skills, R Adams Cowley Shock Trauma Center, University of Maryland Medical Center, 22 South Greene Street, Baltimore, MD 21201.
authors.forename: Victoria B
authors.initials: VB
authors.lastname: Chou
authors.affiliation: Center for the Sustainment of Trauma and Readiness Skills, R Adams Cowley Shock Trauma Center, University of Maryland Medical Center, 22 South Greene Street, Baltimore, MD 21201.
authors.forename: Catriona
authors.initials: C
authors.lastname: Miller
authors.affiliation: 60th Medical Group, David Grant Medical Center, 101 Bodin Circle, Travis Air Force Base, CA 94535.
authors.forename: Bryson
authors.initials: B
authors.lastname: Borg
authors.affiliation: 99th Medical Group, Mike O'Callaghan Federal Medical Center, Nellis Air Force Base, NV 89191.
authors.forename: Nichole
authors.initials: N
authors.lastname: Ingalls
authors.affiliation: Center for the Sustainment of Trauma and Readiness Skills, R Adams Cowley Shock Trauma Center, University of Maryland Medical Center, 22 South Greene Street, Baltimore, MD 21201.
authors.forename: Stacy
authors.initials: S
authors.lastname: Shackelford
mesh_terms: D000328:Adult; D002574:Cervical Vertebrae / Q000293:injuries*; D005260:Female; D015600:Glasgow Coma Scale; D006801:Humans; D015994:Incidence; D008297:Male; D009104:Multiple Trauma; D012189:Retrospective Studies; D013124:Spinal Injuries / Q000175:diagnosis / Q000453:epidemiology*; D014057:Tomography, X-Ray Computed; D014481:United States / Q000453:epidemiology; D014857:Warfare; D014949:Wounds, Nonpenetrating / Q000175:diagnosis / Q000453:epidemiology*