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Blunt Neck Trauma

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1141. Cervical spine injury is highly dependent on the mechanism of injury following blunt and penetrating assault. Full Text available with Trip Pro

Level I trauma centers over 87 and 144 months caused by gunshot wounds (GSW), stab wounds (SW) or blunt assault (BA).During the study period, there were 57,532 trauma patients evaluated at the two trauma centers, of which 42.3% were following blunt or penetrating assault. The rates of CSF and CSCI for the various mechanisms were similar between the two centers. The rates for having CSF were significantly different (p < 0.05) for the various mechanisms. GSW (1.35%) was the highest followed by BA (...) (0.41%) and then SW (0.12%). The rates of CSCI for GSW (0.94%) were significantly (p < 0.05) higher than BA (0.14%) and SW (0.11%). For GSW patients, all patients with CSF or CSCI had a point of entry between the ears and the nipple. For SW patients, the wound was directly in the neck below the mandible and above the trapezius muscle. Although many of the SW patients also suffered blunt assault, none of the CSF or CSCI injuries were from blunt forces. In addition, all patients, both blunt

2006 Journal of Trauma

1142. Computed tomographic angiography for the diagnosis of blunt carotid/vertebral artery injury: a note of caution. (Abstract)

the 40-month study period ending March 2007, approximately 7000 blunt trauma patients were evaluated and of these 119 (1.7%) consecutive patients meeting inclusion criteria were screened by CTA. Ninety-two patients underwent confirmatory DSA. Twenty-three (22%) DSA identified 26 BCVI (vertebral, 13; carotid, 13). Among these 23 CTAs, 17 identified 19 BCVIs (vertebral, 10; carotid, 9) (true positives), and 6 failed to identify 7 BCVIs (vertebral, 3; carotid, 4) (false negatives). Sixty-nine of the 92 (...) Computed tomographic angiography for the diagnosis of blunt carotid/vertebral artery injury: a note of caution. Computed tomographic angiography (CTA) by 16-channel multidetector scanner is increasingly replacing conventional digital subtraction angiography (DSA) for diagnosing or excluding blunt carotid/vertebral injuries (BCVI). To date there has been only 1 study in which all patients received both examinations. That study reported a high accuracy for 16-detector CTA. The current prospective

2007 Annals of Surgery

1143. Blunt carotid artery injury: the futility of aggressive screening and diagnosis. Full Text available with Trip Pro

Blunt carotid artery injury: the futility of aggressive screening and diagnosis. Blunt carotid artery injury (BCI) remains a rare but potentially lethal condition. Recent studies recommend that aggressive screening based on broad criteria (hyperextension-hyperflexion mechanism of injury, basilar skull fracture, cervical spine injury, midface fracture, mandibular fracture, diffuse axonal brain injury, and neck seat-belt sign) increases the rate of diagnosis of BCI by 9-fold (...) trauma centers. In both centers, urgent screening for BCI was performed in patients with focal neurologic signs or neurologic symptoms unexplainable by results of computed tomography of the brain as well as in selected patients undergoing angiography for another reason.Of 35 212 blunt trauma admissions, 17 patients (0.05%) were diagnosed as having BCI. Six showed no evidence of BCI-related neurologic symptoms during hospitalization or prior to death as a result of associated injuries. Eleven

2004 Archives of Surgery

1144. Survival after trauma in geriatric patients. Full Text available with Trip Pro

Survival after trauma in geriatric patients. In contrast to other studies, a recent report from the authors' institution has shown a good prognosis for functional recovery in geriatric patients that survive trauma. Because most survivors regained their pre-injury function, the authors examined factors related to nonsurvival in this population of 82 consecutive blunt trauma victims older than the age of 65. Seventeen patients died (21%). Compared with survivors, nonsurvivors were older, had more (...) severe overall injury, and had more severe head and neck trauma but did not differ in severity of trauma that did not involve the head and neck, number of body regions injured, mechanism of injury, or incidence of surgery after injury. Nonsurvivors experienced more frequent complications (82% vs. 33%, p less than 0.05), including a higher incidence of cardiac complications (53% vs. 15%, p less than 0.05) and ventilator dependence for 5 or more days (41% vs. 14%, p less than 0.05). Mortality rates

1987 Annals of Surgery

1145. Aerobic and anaerobic microbiology of infections after trauma in children. Full Text available with Trip Pro

transport media. Anaerobes and aerobic bacteria were cultured and identified using standard techniques. Clinical records were reviewed to identify post-trauma patients.From 1974 to 1994, 175 specimens obtained from 166 children with trauma showed bacterial growth. The trauma included blunt trauma (71), lacerations (48), bites (42), and open fractures (5). Anaerobic bacteria only were isolated in 38 specimens (22%), aerobic bacteria only in 51 (29%), and mixed aerobic-anaerobic flora in 86 (49%); 363 (...) from head and neck wounds and abscesses, and bites, and those from the gastrointestinal tract predominated in infections that originated from peritonitis, abdominal abscesses, and decubitus ulcers.Many infections that follow trauma in children involve multiple organisms.

1998 Journal of accident & emergency medicine

1146. Laryngeal trauma in sport. Full Text available with Trip Pro

Laryngeal trauma in sport. The larynx and surrounding soft tissues are vulnerable to injury during athletics despite protective equipment and rule modifications. Laryngeal injuries are uncommon but potentially fatal conditions that pose risks to the voice, airway, and esophagus of athletes who sustain blunt or penetrating neck trauma. Common symptoms and signs of laryngeal trauma include hoarseness, dyspnea, hemoptysis, dysphonia, respiratory distress, anterior neck tenderness, subcutaneous

2008 Current Sports Medicine Reports

1147. Clinical practice implications of the Bone and Joint Decade 2000-2010 Task Force on Neck Pain and Its Associated Disorders: from concepts and findings to recommendations. (Abstract)

of major pathology and no or little interference with daily activities; Grade II neck pain with no signs of major pathology, but interference with daily activities; Grade III neck pain with neurologic signs of nerve compression; Grade IV neck pain with signs of major pathology. In the emergency room after blunt trauma to the neck, triage should be based on the NEXUS criteria or the Canadian C-spine rule. Those with a high risk of fracture should be further investigated with plain radiographs and/or CT (...) or Grade II neck pain without trauma. Those with confirmed Grade III and severe persistent radicular symptoms might benefit from corticosteroid injections or surgery. Those with confirmed Grade IV neck pain require management specific to the diagnosed pathology.The best available evidence suggests initial assessment for neck pain should focus on triage into 4 grades, and those with common neck pain (Grade I and Grade II) might be offered the listed noninvasive treatments if short-term relief is desired.

2008 Spine

1148. Urethral and bladder neck injury associated with pelvic fracture in 25 female patients. (Abstract)

, the Incontinence Impact Questionnaire Short Form and the Female Sexual Function Index were sent to the patients.A total of 25 patients (13 adults, 12 children) with a mean age of 22 years (range 4 to 67) met inclusion criteria. All had pelvic fracture related to blunt trauma. They represented 6% of all female patients treated in the same review period with pelvic fracture. Blood was seen at the introitus in 15 patients and 19 had gross hematuria. Of the injuries 9 were avulsions, 15 were longitudinal (...) Urethral and bladder neck injury associated with pelvic fracture in 25 female patients. We describe the presentation, diagnostic evaluation, management and outcome of female urethral trauma.All female patients treated at Harborview Medical Center between 1985 and 2001 with urethral injury were identified by International Classification of Diseases 9th revision code. Approval of the Human Subject Division was obtained and patient charts were reviewed. The Urogenital Distress Inventory Short Form

2006 Journal of Urology

1149. Pharyngeal perforation with deep neck abscess secondary to isolated hyoid bone fracture. (Abstract)

Pharyngeal perforation with deep neck abscess secondary to isolated hyoid bone fracture. We report the case of a 26-year-old man who presented to us with dysphagia secondary to blunt trauma to the neck. The patient was found to have a hyoid bone fracture with pharyngeal perforation and resultant neck abscess. The patient responded to prompt surgical and medical management. We believe this to be the first report of such a case.

2005 Journal of Laryngology & Otology

1150. Assessment of neck pain and its associated disorders: results of the Bone and Joint Decade 2000-2010 Task Force on Neck Pain and Its Associated Disorders. (Abstract)

conducted a critical review of the literature (published 1980-2006) on assessment tools and screening protocols for traumatic and nontraumatic neck pain.We found 359 articles on assessment of neck pain. After critical review, 95 (35%) were judged scientifically admissible. Screening protocols have high predictive values to detect cervical spine fracture in alert, low-risk patients seeking emergency care after blunt neck trauma. Computerized tomography (CT) scans had better validity (in adults (...) and elderly) than radiographs in assessing high-risk and/or multi-injured blunt trauma neck patients. In the absence of serious pathology, clinical physical examinations are more predictive at excluding than confirming structural lesions causing neurologic compression. One exception is the manual provocation test for cervical radiculopathy, which has high positive predictive value. There was no evidence that specific MRI findings are associated with neck pain, cervicogenic headache, or whiplash exposure

2008 Spine

1151. A case of Brown-Sequard syndrome with associated Horner's syndrome after blunt injury to the cervical spine Full Text available with Trip Pro

A case of Brown-Sequard syndrome with associated Horner's syndrome after blunt injury to the cervical spine A 26 year old motorcyclist was received by the trauma team in our accident and emergency department after a head on collision with a motor vehicle. He had been correctly immobilised and his primary survey was essentially normal. He was alert and orientated with a Glasgow Coma score of 15 and had no symptoms or signs of spinal injury. His cervical spine radiography was also normal (...) and he underwent surgery to fuse his spine at the C5-C6 level. This report highlights the necessity to observe strict ATLS guidelines. This must include a thorough examination of the central and peripheral nervous system where spinal injury is suspected, even in the absence of radiographic abnormality and neck pain. This article also presents the unusual phenomena of Brown-Sequard syndrome and unilateral Horner's syndrome after blunt traumatic injury to the cervical spine.

2001 Emergency Medicine Journal : EMJ

1152. Blunt carotid injury. Importance of early diagnosis and anticoagulant therapy. Full Text available with Trip Pro

Blunt carotid injury. Importance of early diagnosis and anticoagulant therapy. The incidence, associated injury pattern, diagnostic factors, risk for adverse outcome, and efficacy of anticoagulant therapy in the setting of blunt and carotid injury (BCI) were evaluated.Blunt carotid injury is considered uncommon. The authors believe that it is underdiagnosed. Outcome is thought to be compromised by diagnostic delay. If delay in diagnosis is important, it is implied that therapy is effective (...) . Although anticoagulation is the most frequently used therapy, efficacy has not been proven.Patients with BCI were identified from the registry of a level I trauma center during an 11-year period (ending September 1995). Neurologic examinations and outcomes, brain computed tomography (CT) results, angiographic findings, risk factors, and heparin therapy were evaluated.Sixty-seven patients with 87 BCIs were treated. Thirty-four percent were diagnosed by incompatible neurologic and CT findings, 43% by new

1996 Annals of Surgery

1153. Prospective screening for blunt cerebrovascular injuries: analysis of diagnostic modalities and outcomes. Full Text available with Trip Pro

of patients with blunt head and neck trauma identified an incidence of BCVI in 1.03% of blunt admissions. Early identification, which led to early treatment, significantly reduced stroke rates in patients with VAI, but provided no outcome improvement with CAI. More encompassing screening may be required to improve outcomes for patients with CAI. However, less-invasive diagnostic techniques (CTA and MRA) are inadequate for screening. Technological advances are necessary before abandonment of conventional (...) or antiplatelet therapy was instituted unless clinically contraindicated. Results of this screening protocol were compared to a previously published cohort with cerebrovascular injuries (1995-1999) from the authors' institution.Two hundred sixteen patients were screened over a 2-year period (3.5% of all blunt trauma admissions). Angiography identified 24 patients with carotid artery injuries (CAI) and 43 patients with vertebral artery injuries (VAI) for an overall screening yield of 29%. While the incidence

2002 Annals of Surgery

1154. Incidence and pattern of direct blunt neurovascular injury associated with trauma to the skull base. Full Text available with Trip Pro

Incidence and pattern of direct blunt neurovascular injury associated with trauma to the skull base. Skull base fractures are often associated with potentially devastating injuries to major neural arteries in the head and neck, but the incidence and pattern of this association are unknown.Between April and September 2002, 1738 Level 1 trauma patients were admitted to St. Joseph's Hospital and Medical Center in Phoenix, Arizona. Among them, a skull base fracture was diagnosed in 78 patients (...) neurovascular injuries were identified in six (8.5%) of the 71 patients. Fractures of the clivus were very likely to be associated with neurovascular injury (p < 0.001). A high risk of neurovascular injury showed a strong tendency to be associated with fractures of the sella turcica-sphenoid sinus complex (p = 0.07).The risk of associated blunt neurovascular injury appears to be significant in Level 1 trauma patients in whom a diagnosis of skull base fracture has been made using CT. The incidence

2007 Journal of Neurosurgery

1155. Are computed tomography scans adequate in assessing cervical spine pain following blunt trauma? Full Text available with Trip Pro

. In this way, the use of dynamic radiographs following blunt cervical trauma should be considered an effective tool for managing acute cervical spine injury in the awake, alert, and neurologically intact patient with neck pain. (...) Are computed tomography scans adequate in assessing cervical spine pain following blunt trauma? Good quality three-view radiographs (anteroposterior, lateral, and open-mouth/odontoid) of the cervical spine exclude most unstable injuries, with sensitivity as high as 92% in adults and 94% in children. The diagnostic performance of helical computed tomography (CT) scanners may be even greater, with reported sensitivity as high as 99% and specificity 93%. Missed injuries are usually ligamentous

2007 Emergency Medicine Journal

1156. Blunt laryngeal trauma in children: case report and review of initial airway management. (Abstract)

Blunt laryngeal trauma in children: case report and review of initial airway management. Blunt neck trauma is not common in children, but these injuries can be potentially life-threatening. Presenting symptoms and signs of laryngeal injuries are often subtle, and poor outcomes in regard to voice and airway function are associated with delayed diagnosis. The purpose of this report was to present a pediatric case that illustrates the subtle symptoms and signs of a laryngeal laceration (...) . In this case, the appearance of the laryngeal laceration was similar to the glottis, highlighting the importance of developing airway management guidelines for blunt laryngeal injuries in children.

2008 Pediatric Emergency Care

1157. Blunt thyroid trauma with acute hemorrhage and respiratory distress. (Abstract)

Blunt thyroid trauma with acute hemorrhage and respiratory distress. We report a rare event of acute hemorrhage into a thyroid adenoma after blunt trauma and causing respiratory distress. A 65-year-old woman fell and hit the left side of her anterior neck without any other injuries. The next day, she suffered from severe dyspnea and respiratory distress, and visited a community hospital. She required endotracheal intubation and was immediately transferred to a regional emergency center

2007 Journal of Emergency Medicine

1158. Utility of screening for blunt vascular neck injuries with computed tomographic angiography. (Abstract)

Utility of screening for blunt vascular neck injuries with computed tomographic angiography. To prospectively study the impact of implementing a computed tomographic angiography (CTA)-based screening protocol on the detected incidence and associated morbidity and mortality of blunt vascular neck injury (BVNI).Consecutive blunt trauma patients admitted to a single tertiary trauma center and identified as at risk for BVNI underwent admission CTA using an eight-slice multi-detector computed (...) tomography scanner. The detected incidence, morbidity, and mortality rates of BVNI were compared with those measured before CTA screening. A logistic regression model was also applied to further evaluate potential risk factors for BVNI.A total of 1,313 blunt trauma patients were evaluated. One hundred seventy screening CTAs were performed, of which 33 disclosed abnormalities. Twenty-three were evaluated angiographically, of which 15 were considered to have significant BVNIs, as were 4 of the 10 patients

2006 Journal of Trauma

1159. Phrenic nerve injury following blunt trauma Full Text available with Trip Pro

Phrenic nerve injury following blunt trauma Phrenic nerve trauma in the absence of direct injury is unusual and may present diagnostic difficulty. Diaphragmatic paralysis resulting from phrenic nerve injury may closely mimic diaphragmatic rupture. This case highlights the value of magnetic resonance imaging in establishing diaphragmatic integrity and of ultrasonographic assessment during respiratory excursion in confirming diaphragmatic paralysis. In cases of non-contact injury involving (...) torsional injury to the neck, an index of clinical awareness may help to establish the diagnosis of phrenic nerve trauma.

2000 Journal of accident & emergency medicine

1160. Prediction of prolonged ventilatory support in blunt thoracic trauma patients. (Abstract)

Prediction of prolonged ventilatory support in blunt thoracic trauma patients. To identify predictors of prolonged (>7 days) mechanical ventilation (MV) in patients with blunt thoracic trauma.Prospective analysis of consecutive patients.Adult intensive care unit (ICU) in a teaching, tertiary-care hospital.Sixty-nine patients (53 men, 16 women) with thoracic trauma having a median age of 35 (range 17-85) years and a median injury severity score (ISS) of 29 (range 14-41) were enrolled (...) in the present study. Associated injuries included head-neck (77%), extremities (72%), external (67%), abdomen-pelvis (67%), and face (55%).Patient surveillance and data collection.Thirty-three (48%) of the 69 patients required prolonged ventilatory support, ranging in duration from 8 to 38 (median 18) days. Logistic regression analysis revealed that advancing age (odds ratio=1.04, p=0.04), severity of head injury (odds ratio=1.92, p=0.008), and bilateral thoracic injuries (odds ratio=12.80, p<0.0001) were

2003 Intensive Care Medicine

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