Are We Taking Care of Cervical Injuries Properly?

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Permalink Reply by Todd Webb on August 6, 2009 at 7:27am

Here is the web sites I was given by my office to where the statistics came from on a total of 25% of cervical spine injuries occur after the initial injury, termed secondary injury, either during transport or in the early course of treatment.’’.
You may access the full article if you click on the link: http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=419507. Hope this is what you were looking for.

Michael Fraley said:

Todd, I would still like to see these documents. I have looked back through this thread and do not see them. If you are going to drop names you really should be prepared to provide the proof. Please either post a specific website URL or full citation of the study. Thanks.

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Permalink Reply by Todd Webb on August 6, 2009 at 6:08pm

Lee,

Here are additional information I was given from my company, please look at the following websites:

We quote the data after the study by Colleen Y. James, Bryan L. Riemann, Barry A. Munkasy and A. Barry Joyner published in the Journal of Athletic Training 2004 Apr–Jun; 39(2): 138–145 entitled ,,Comparison of Cervical Spine Motion During Application Among 4 Rigid Immobilization Collars’’. The specific passage says: ,, A total of 25% of cervical spine injuries occur after the initial injury, termed secondary injury, either during transport or in the early course of treatment.’’. You may access the full article if you click on the link:

http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=419507



Authors quote the statistic in question after the paper by Askins V, Eismont FJ., ,,Efficacy of five cervical orthoses in restricting cervical motion: a comparison study’’ from Spine. 1997;17:1193–1198. The abstract of this article is accessible on this page:

http://journals.lww.com/spinejournal/Abstract/1997/06010/Efficacy__...



We found the same statistic on the DOT-National Highway Traffic Safety Administration webpage under the link:

http://www.nhtsa.dot.gov/portal/site/nhtsa/menuitem.2a0771e91315bab...



As well as in Suspected Spinal Injury Protocol Update for New York State Department of Health Bureau of Emergency Medical Services, under the link:

http://www.health.state.ny.us/nysdoh/ems/pdf/module5_4.pdf

(New York State Department of Health Bureau of Emergency Medical Services, Suspected Spinal Injury Protocol Update 02/2008 page 5)



After further research, we came across these:

Spinal cord injury: progress, promise, and priorities, Committee on Spinal Cord injury Board on Neuroscience and Behavioral Health; Ed.: Catharyn T. Liverman, Bruce M. Altevogt, Janet E. Joy and Richard T. Johnson; National Academies Press, 2005, p. 97 – quoted after Hachen HJ: Emergency Transportation in the event of acute spinal cord lesion. Paraplegia, 12: 33-37, 1974.

Spinal cord medicine: principles and practice by Vernon W. Lin, Diana D. Cardenas, Published by Demos Medical Publishing, LLC, 2002, p. 110 (quoted after Podolsky S, Baraff LJ, Simon RR Efficacy of Cervical spine immobilization methods, J Trauma 1983; 23:461-465.



Lee said:

Thanks Todd, a very informative paper.

I see some issues, with this study.

Whether supine or seated, the measurements were done with the collar only. Without securing the "model" to a spine board or other extrication device, there will be movement. I realize the study was to measure motion, but have more accurate figures, measurements should be taken as they are actually done in the field.

"Once the collar was applied, the model remained supine... The model then moved to a standard wooden chair and sat upright"....

This is suspect because there will always be a difference due to body movement when getting into the chair, just as there would be going from the chair to a supine position.

And lastly, the study was geared toward athletic trainers,

"certified athletic trainers (ATCs) and on-site medical staffs are unlikely to have much real-life experience managing a cervical spine– injured athlete".

I agree with that statement, if we are only talking about athletic injuries. Depending on the service area, most of us see actual cervical spine injuries almost daily, sometimes several a day. I am in no way belittling athletic trainers. I've worked with many exceptional ones, but I doubt that the 25% is accurate in the EMS setting, at least not the stats I've seen.

Todd Webb said:

Here is the web sites I was given by my office to where the statistics came from on a total of 25% of cervical spine injuries occur after the initial injury, termed secondary injury, either during transport or in the early course of treatment.’’.
You may access the full article if you click on the link: http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=419507. Hope this is what you were looking for.

Michael Fraley said:

Todd, I would still like to see these documents. I have looked back through this thread and do not see them. If you are going to drop names you really should be prepared to provide the proof. Please either post a specific website URL or full citation of the study. Thanks.

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Permalink Reply by Michael Fraley on August 16, 2009 at 10:28am

Thank you Todd. I have read the J Athl Train article and agree with Lee's comments. The link to the DOT only takes me to a page that lists a bunch of other pages. And the other references are only repeating the 25% cited in the Askins study. I am still trying to get access to that entire article.

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