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William R Mower - One of the best experts on this subject based on the ideXlab platform.
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Variability in computed tomography and magnetic resonance imaging in patients with Cervical Spine injuries.
Journal of Trauma-injury Infection and Critical Care, 2002Co-Authors: James F. Holmes, Stuart E. Mirvis, Edward A Panacek, Jerome R. Hoffman, William R MowerAbstract:Objective: The purpose of this study was to describe the performance of adjunctive radiologic imaging in patients with Cervical Spine injury. Methods: All patients undergoing Cervical Spine Radiography were prospectively enrolled at 16 diverse emergency departments. We recorded the imaging modalities and radiographic interpretations rendered by unblinded faculty radiologists at each center. Only patients with Cervical Spine injury were included in this analysis. Findings revealed by individual modalities were compared with the final diagnosis (after all evaluations) in each patient. Results: Six hundred eighty-eight patients with 1,302 separate Cervical Spine injuries were enrolled. Four hundred seventy-six (69%) patients had magnetic resonance imaging (MRI) and/or computed tomography (CT) of the Cervical Spine. MRI identified the following injuries among 124 imaged patients: osseous fractures, 85 of 154 (55%); spinal cord injury, 69 of 69 (100%); vertebral subluxation/ dislocation, 37 of 43 (86%); ligamentous injury, 38 of 38 (100%); and unilateral/ bilateral locked facets, 14 of 18 (78%). Among 418 patients undergoing CT, the following injuries were identified: osseous fractures, 721 of 740 (97%); spinal cord injury, 0 of 30 (0%); vertebral subluxation/dislocation, 76 of 88 (86%); ligamentous injury, 9 of 36 (25%); and unilateral/ bilateral locked facets, 34 of 35 (97%). CT identified 29 patients with fractures who had normal plain radiographs. Cervical myelograms were obtained in two patients and Cervical tomograms in seven patients. Conclusion: The majority of patients with Cervical Spine injury undergo MRI and/or CT imaging. In clinical practice, MRI is superior at identifying soft tissue injuries, whereas CT performs better in identifying bony injuries. Cervical myelograms and tomograms are rarely obtained.
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validity of a decision rule to reduce Cervical Spine Radiography in elderly patients with blunt trauma
Annals of Emergency Medicine, 2002Co-Authors: Michael Touger, Douglas W. Lowery, Jerome R. Hoffman, Paul Gennis, Noel Nathanson, Charles V Pollack, William R MowerAbstract:Abstract Study objective: A decision instrument based on 5 clinical criteria has been shown to be highly sensitive in selecting patients who require Cervical Spine imaging after blunt trauma, while simultaneously reducing overall imaging. We examine the performance of this instrument in the elderly and explore some of the common features of geriatric Cervical Spine injury (CSI). Methods: The National Emergency X-Radiography Utilization Study (NEXUS) was a prospective, observational, multicenter study conducted at 21 geographically diverse centers. We analyzed the performance of the NEXUS decision instrument among patients at least 65 years of age. Results: The study group consisted of 2,943 (8.6%) geriatric patients, representing 8.6% of the entire NEXUS sample. The rate of CSI was twice as great in these patients as it was in nongeriatric patients (4.59% versus 2.19%). Odontoid fractures were particularly common in geriatric patients, accounting for 20% of geriatric fractures compared with 5% of nongeriatric fractures. The frequency of patients meeting NEXUS criteria was similar in the 2 groups, with 14% of geriatric patients and 12.5% of nongeriatric patient classified as low risk. CSI occurred in only 2 low-risk geriatric patients, and these patients' injuries met our preset definition of a clinically insignificant injury. The sensitivity of the NEXUS decision instrument for clinically significant injury in the geriatric group was therefore 100% (95% confidence interval 97.1% to 100%). Conclusion: The prevalence of CSI, and especially odontoid fracture, is relatively increased among geriatric patients with blunt trauma. The NEXUS decision instrument can be applied safely to these patients, with an expected reduction in Cervical imaging comparable with that achieved in nongeriatric patients. [ Ann Emerg Med. 2002;40:287-293.]
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Epidemiology of Cervical Spine injury victims
Annals of Emergency Medicine, 2001Co-Authors: Douglas W. Lowery, Marlena M. Wald, Brian J. Browne, Stefan Tigges, Jerome R. Hoffman, William R MowerAbstract:STUDY OBJECTIVE: We sought to characterize demographics and injury patterns among patients undergoing emergency department Cervical Spine Radiography for blunt traumatic injury. METHODS: All patients with blunt trauma undergoing Cervical Spine Radiography at 21 centers were enrolled in this prospective, observational study. Patients' date of birth, age, sex, and ethnicity were noted before Cervical Spine Radiography. RESULTS: Demographic factors associated with Cervical Spine injury, present in 818 of 33,922 patients, included the following: age of 65 years or older (relative risk [RR] 2.09; 95% confidence interval [CI] 1.77 to 2.59); "other" ethnicity (RR 1.79, 95% CI 1.46 to 2.19); male sex (RR 1.72, 95% CI 1.48 to 2.00); and white ethnicity (RR 1.50, 95% CI 1.31 to 1.72). Hispanic ethnicity (RR 0.64, 95% CI 0.51 to 0.79), female sex (RR 0.58, 95% CI 0.50 to 0.67), black ethnicity (RR 0.55, 95% CI 0.45 to 0.66), and age of less than 18 years (RR 0.39, 95% CI 0.27 to 0.55) were associated with reduced risk of Cervical Spine injury. CONCLUSION: Among patients undergoing ED Cervical Spine Radiography, Cervical Spine injury is more common among the elderly, male subjects, and patients of white or "other" ethnicity. Because Cervical Spine injury occurs in patients in all demographic categories, however, this information cannot be used to select individual patients who should or should not undergo imaging.
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Epidemiology of Cervical Spine injury victims
Annals of emergency medicine, 2001Co-Authors: Douglas W. Lowery, Marlena M. Wald, Brian J. Browne, Stefan Tigges, Jerome R. Hoffman, William R MowerAbstract:Abstract Study Objective: We sought to characterize demographics and injury patterns among patients undergoing emergency department Cervical Spine Radiography for blunt traumatic injury. Methods: All patients with blunt trauma undergoing Cervical Spine Radiography at 21 centers were enrolled in this prospective, observational study. Patients' date of birth, age, sex, and ethnicity were noted before Cervical Spine Radiography. Results: Demographic factors associated with Cervical Spine injury, present in 818 of 33,922 patients, included the following: age of 65 years or older (relative risk [RR] 2.09; 95% confidence interval [CI] 1.77 to 2.59); "other" ethnicity (RR 1.79, 95% CI 1.46 to 2.19); male sex (RR 1.72, 95% CI 1.48 to 2.00); and white ethnicity (RR 1.50, 95% CI 1.31 to 1.72). Hispanic ethnicity (RR 0.64, 95% CI 0.51 to 0.79), female sex (RR 0.58, 95% CI 0.50 to 0.67), black ethnicity (RR 0.55, 95% CI 0.45 to 0.66), and age of less than 18 years (RR 0.39, 95% CI 0.27 to 0.55) were associated with reduced risk of Cervical Spine injury. Conclusion: Among patients undergoing ED Cervical Spine Radiography, Cervical Spine injury is more common among the elderly, male subjects, and patients of white or "other" ethnicity. Because Cervical Spine injury occurs in patients in all demographic categories, however, this information cannot be used to select individual patients who should or should not undergo imaging.[Lowery DW, Wald MM, Browne BJ, Tigges S, Hoffman JR, Mower WR, for the NEXUS Group. Epidemiology of Cervical Spine injury victims. Ann Emerg Med. July 2001;38:12-16.]
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selective Cervical Spine Radiography in blunt trauma methodology of the national emergency x Radiography utilization study nexus
Annals of Emergency Medicine, 1998Co-Authors: Jerome R. Hoffman, Allan B Wolfson, Knox H Todd, William R MowerAbstract:Fear of failure to identify Cervical Spine injury has led to extremely liberal use of Radiography in patients with blunt trauma and remotely possible neck injury. A number of previous retrospective and small prospective studies have tried to address the question of whether any clinical criteria can identify patients, from among this group, at sufficiently low risk that Cervical Spine Radiography is unnecessary. The National Emergency X-Radiography Utilization Study (NEXUS) is a very large, federally supported, multicenter, prospective study designed to define the sensitivity, for detecting significant Cervical Spine injury, of criteria previously shown to have high negative predictive value. Done at 23 different emergency departments across the United States and projected to enroll more than 20 times as many patients with Cervical Spine injury than any previous study, NEXUS should be able to answer definitively questions about the validity and reliability of clinical criteria used as a preliminary screen for Cervical Spine injury.
Jerome R. Hoffman - One of the best experts on this subject based on the ideXlab platform.
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Variability in computed tomography and magnetic resonance imaging in patients with Cervical Spine injuries.
Journal of Trauma-injury Infection and Critical Care, 2002Co-Authors: James F. Holmes, Stuart E. Mirvis, Edward A Panacek, Jerome R. Hoffman, William R MowerAbstract:Objective: The purpose of this study was to describe the performance of adjunctive radiologic imaging in patients with Cervical Spine injury. Methods: All patients undergoing Cervical Spine Radiography were prospectively enrolled at 16 diverse emergency departments. We recorded the imaging modalities and radiographic interpretations rendered by unblinded faculty radiologists at each center. Only patients with Cervical Spine injury were included in this analysis. Findings revealed by individual modalities were compared with the final diagnosis (after all evaluations) in each patient. Results: Six hundred eighty-eight patients with 1,302 separate Cervical Spine injuries were enrolled. Four hundred seventy-six (69%) patients had magnetic resonance imaging (MRI) and/or computed tomography (CT) of the Cervical Spine. MRI identified the following injuries among 124 imaged patients: osseous fractures, 85 of 154 (55%); spinal cord injury, 69 of 69 (100%); vertebral subluxation/ dislocation, 37 of 43 (86%); ligamentous injury, 38 of 38 (100%); and unilateral/ bilateral locked facets, 14 of 18 (78%). Among 418 patients undergoing CT, the following injuries were identified: osseous fractures, 721 of 740 (97%); spinal cord injury, 0 of 30 (0%); vertebral subluxation/dislocation, 76 of 88 (86%); ligamentous injury, 9 of 36 (25%); and unilateral/ bilateral locked facets, 34 of 35 (97%). CT identified 29 patients with fractures who had normal plain radiographs. Cervical myelograms were obtained in two patients and Cervical tomograms in seven patients. Conclusion: The majority of patients with Cervical Spine injury undergo MRI and/or CT imaging. In clinical practice, MRI is superior at identifying soft tissue injuries, whereas CT performs better in identifying bony injuries. Cervical myelograms and tomograms are rarely obtained.
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validity of a decision rule to reduce Cervical Spine Radiography in elderly patients with blunt trauma
Annals of Emergency Medicine, 2002Co-Authors: Michael Touger, Douglas W. Lowery, Jerome R. Hoffman, Paul Gennis, Noel Nathanson, Charles V Pollack, William R MowerAbstract:Abstract Study objective: A decision instrument based on 5 clinical criteria has been shown to be highly sensitive in selecting patients who require Cervical Spine imaging after blunt trauma, while simultaneously reducing overall imaging. We examine the performance of this instrument in the elderly and explore some of the common features of geriatric Cervical Spine injury (CSI). Methods: The National Emergency X-Radiography Utilization Study (NEXUS) was a prospective, observational, multicenter study conducted at 21 geographically diverse centers. We analyzed the performance of the NEXUS decision instrument among patients at least 65 years of age. Results: The study group consisted of 2,943 (8.6%) geriatric patients, representing 8.6% of the entire NEXUS sample. The rate of CSI was twice as great in these patients as it was in nongeriatric patients (4.59% versus 2.19%). Odontoid fractures were particularly common in geriatric patients, accounting for 20% of geriatric fractures compared with 5% of nongeriatric fractures. The frequency of patients meeting NEXUS criteria was similar in the 2 groups, with 14% of geriatric patients and 12.5% of nongeriatric patient classified as low risk. CSI occurred in only 2 low-risk geriatric patients, and these patients' injuries met our preset definition of a clinically insignificant injury. The sensitivity of the NEXUS decision instrument for clinically significant injury in the geriatric group was therefore 100% (95% confidence interval 97.1% to 100%). Conclusion: The prevalence of CSI, and especially odontoid fracture, is relatively increased among geriatric patients with blunt trauma. The NEXUS decision instrument can be applied safely to these patients, with an expected reduction in Cervical imaging comparable with that achieved in nongeriatric patients. [ Ann Emerg Med. 2002;40:287-293.]
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Epidemiology of Cervical Spine injury victims
Annals of Emergency Medicine, 2001Co-Authors: Douglas W. Lowery, Marlena M. Wald, Brian J. Browne, Stefan Tigges, Jerome R. Hoffman, William R MowerAbstract:STUDY OBJECTIVE: We sought to characterize demographics and injury patterns among patients undergoing emergency department Cervical Spine Radiography for blunt traumatic injury. METHODS: All patients with blunt trauma undergoing Cervical Spine Radiography at 21 centers were enrolled in this prospective, observational study. Patients' date of birth, age, sex, and ethnicity were noted before Cervical Spine Radiography. RESULTS: Demographic factors associated with Cervical Spine injury, present in 818 of 33,922 patients, included the following: age of 65 years or older (relative risk [RR] 2.09; 95% confidence interval [CI] 1.77 to 2.59); "other" ethnicity (RR 1.79, 95% CI 1.46 to 2.19); male sex (RR 1.72, 95% CI 1.48 to 2.00); and white ethnicity (RR 1.50, 95% CI 1.31 to 1.72). Hispanic ethnicity (RR 0.64, 95% CI 0.51 to 0.79), female sex (RR 0.58, 95% CI 0.50 to 0.67), black ethnicity (RR 0.55, 95% CI 0.45 to 0.66), and age of less than 18 years (RR 0.39, 95% CI 0.27 to 0.55) were associated with reduced risk of Cervical Spine injury. CONCLUSION: Among patients undergoing ED Cervical Spine Radiography, Cervical Spine injury is more common among the elderly, male subjects, and patients of white or "other" ethnicity. Because Cervical Spine injury occurs in patients in all demographic categories, however, this information cannot be used to select individual patients who should or should not undergo imaging.
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Epidemiology of Cervical Spine injury victims
Annals of emergency medicine, 2001Co-Authors: Douglas W. Lowery, Marlena M. Wald, Brian J. Browne, Stefan Tigges, Jerome R. Hoffman, William R MowerAbstract:Abstract Study Objective: We sought to characterize demographics and injury patterns among patients undergoing emergency department Cervical Spine Radiography for blunt traumatic injury. Methods: All patients with blunt trauma undergoing Cervical Spine Radiography at 21 centers were enrolled in this prospective, observational study. Patients' date of birth, age, sex, and ethnicity were noted before Cervical Spine Radiography. Results: Demographic factors associated with Cervical Spine injury, present in 818 of 33,922 patients, included the following: age of 65 years or older (relative risk [RR] 2.09; 95% confidence interval [CI] 1.77 to 2.59); "other" ethnicity (RR 1.79, 95% CI 1.46 to 2.19); male sex (RR 1.72, 95% CI 1.48 to 2.00); and white ethnicity (RR 1.50, 95% CI 1.31 to 1.72). Hispanic ethnicity (RR 0.64, 95% CI 0.51 to 0.79), female sex (RR 0.58, 95% CI 0.50 to 0.67), black ethnicity (RR 0.55, 95% CI 0.45 to 0.66), and age of less than 18 years (RR 0.39, 95% CI 0.27 to 0.55) were associated with reduced risk of Cervical Spine injury. Conclusion: Among patients undergoing ED Cervical Spine Radiography, Cervical Spine injury is more common among the elderly, male subjects, and patients of white or "other" ethnicity. Because Cervical Spine injury occurs in patients in all demographic categories, however, this information cannot be used to select individual patients who should or should not undergo imaging.[Lowery DW, Wald MM, Browne BJ, Tigges S, Hoffman JR, Mower WR, for the NEXUS Group. Epidemiology of Cervical Spine injury victims. Ann Emerg Med. July 2001;38:12-16.]
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selective Cervical Spine Radiography in blunt trauma methodology of the national emergency x Radiography utilization study nexus
Annals of Emergency Medicine, 1998Co-Authors: Jerome R. Hoffman, Allan B Wolfson, Knox H Todd, William R MowerAbstract:Fear of failure to identify Cervical Spine injury has led to extremely liberal use of Radiography in patients with blunt trauma and remotely possible neck injury. A number of previous retrospective and small prospective studies have tried to address the question of whether any clinical criteria can identify patients, from among this group, at sufficiently low risk that Cervical Spine Radiography is unnecessary. The National Emergency X-Radiography Utilization Study (NEXUS) is a very large, federally supported, multicenter, prospective study designed to define the sensitivity, for detecting significant Cervical Spine injury, of criteria previously shown to have high negative predictive value. Done at 23 different emergency departments across the United States and projected to enroll more than 20 times as many patients with Cervical Spine injury than any previous study, NEXUS should be able to answer definitively questions about the validity and reliability of clinical criteria used as a preliminary screen for Cervical Spine injury.
Douglas W. Lowery - One of the best experts on this subject based on the ideXlab platform.
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validity of a decision rule to reduce Cervical Spine Radiography in elderly patients with blunt trauma
Annals of Emergency Medicine, 2002Co-Authors: Michael Touger, Douglas W. Lowery, Jerome R. Hoffman, Paul Gennis, Noel Nathanson, Charles V Pollack, William R MowerAbstract:Abstract Study objective: A decision instrument based on 5 clinical criteria has been shown to be highly sensitive in selecting patients who require Cervical Spine imaging after blunt trauma, while simultaneously reducing overall imaging. We examine the performance of this instrument in the elderly and explore some of the common features of geriatric Cervical Spine injury (CSI). Methods: The National Emergency X-Radiography Utilization Study (NEXUS) was a prospective, observational, multicenter study conducted at 21 geographically diverse centers. We analyzed the performance of the NEXUS decision instrument among patients at least 65 years of age. Results: The study group consisted of 2,943 (8.6%) geriatric patients, representing 8.6% of the entire NEXUS sample. The rate of CSI was twice as great in these patients as it was in nongeriatric patients (4.59% versus 2.19%). Odontoid fractures were particularly common in geriatric patients, accounting for 20% of geriatric fractures compared with 5% of nongeriatric fractures. The frequency of patients meeting NEXUS criteria was similar in the 2 groups, with 14% of geriatric patients and 12.5% of nongeriatric patient classified as low risk. CSI occurred in only 2 low-risk geriatric patients, and these patients' injuries met our preset definition of a clinically insignificant injury. The sensitivity of the NEXUS decision instrument for clinically significant injury in the geriatric group was therefore 100% (95% confidence interval 97.1% to 100%). Conclusion: The prevalence of CSI, and especially odontoid fracture, is relatively increased among geriatric patients with blunt trauma. The NEXUS decision instrument can be applied safely to these patients, with an expected reduction in Cervical imaging comparable with that achieved in nongeriatric patients. [ Ann Emerg Med. 2002;40:287-293.]
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Epidemiology of Cervical Spine injury victims
Annals of Emergency Medicine, 2001Co-Authors: Douglas W. Lowery, Marlena M. Wald, Brian J. Browne, Stefan Tigges, Jerome R. Hoffman, William R MowerAbstract:STUDY OBJECTIVE: We sought to characterize demographics and injury patterns among patients undergoing emergency department Cervical Spine Radiography for blunt traumatic injury. METHODS: All patients with blunt trauma undergoing Cervical Spine Radiography at 21 centers were enrolled in this prospective, observational study. Patients' date of birth, age, sex, and ethnicity were noted before Cervical Spine Radiography. RESULTS: Demographic factors associated with Cervical Spine injury, present in 818 of 33,922 patients, included the following: age of 65 years or older (relative risk [RR] 2.09; 95% confidence interval [CI] 1.77 to 2.59); "other" ethnicity (RR 1.79, 95% CI 1.46 to 2.19); male sex (RR 1.72, 95% CI 1.48 to 2.00); and white ethnicity (RR 1.50, 95% CI 1.31 to 1.72). Hispanic ethnicity (RR 0.64, 95% CI 0.51 to 0.79), female sex (RR 0.58, 95% CI 0.50 to 0.67), black ethnicity (RR 0.55, 95% CI 0.45 to 0.66), and age of less than 18 years (RR 0.39, 95% CI 0.27 to 0.55) were associated with reduced risk of Cervical Spine injury. CONCLUSION: Among patients undergoing ED Cervical Spine Radiography, Cervical Spine injury is more common among the elderly, male subjects, and patients of white or "other" ethnicity. Because Cervical Spine injury occurs in patients in all demographic categories, however, this information cannot be used to select individual patients who should or should not undergo imaging.
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Epidemiology of Cervical Spine injury victims
Annals of emergency medicine, 2001Co-Authors: Douglas W. Lowery, Marlena M. Wald, Brian J. Browne, Stefan Tigges, Jerome R. Hoffman, William R MowerAbstract:Abstract Study Objective: We sought to characterize demographics and injury patterns among patients undergoing emergency department Cervical Spine Radiography for blunt traumatic injury. Methods: All patients with blunt trauma undergoing Cervical Spine Radiography at 21 centers were enrolled in this prospective, observational study. Patients' date of birth, age, sex, and ethnicity were noted before Cervical Spine Radiography. Results: Demographic factors associated with Cervical Spine injury, present in 818 of 33,922 patients, included the following: age of 65 years or older (relative risk [RR] 2.09; 95% confidence interval [CI] 1.77 to 2.59); "other" ethnicity (RR 1.79, 95% CI 1.46 to 2.19); male sex (RR 1.72, 95% CI 1.48 to 2.00); and white ethnicity (RR 1.50, 95% CI 1.31 to 1.72). Hispanic ethnicity (RR 0.64, 95% CI 0.51 to 0.79), female sex (RR 0.58, 95% CI 0.50 to 0.67), black ethnicity (RR 0.55, 95% CI 0.45 to 0.66), and age of less than 18 years (RR 0.39, 95% CI 0.27 to 0.55) were associated with reduced risk of Cervical Spine injury. Conclusion: Among patients undergoing ED Cervical Spine Radiography, Cervical Spine injury is more common among the elderly, male subjects, and patients of white or "other" ethnicity. Because Cervical Spine injury occurs in patients in all demographic categories, however, this information cannot be used to select individual patients who should or should not undergo imaging.[Lowery DW, Wald MM, Browne BJ, Tigges S, Hoffman JR, Mower WR, for the NEXUS Group. Epidemiology of Cervical Spine injury victims. Ann Emerg Med. July 2001;38:12-16.]
Jeffrey S. Young - One of the best experts on this subject based on the ideXlab platform.
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ED use of flexion-extension Cervical Spine Radiography in the evaluation of blunt trauma.
The American journal of emergency medicine, 1999Co-Authors: William J. Brady, John Moghtader, Daniel Cutcher, Charlie Exline, Jeffrey S. YoungAbstract:Dynamic Cervical Spine Radiography (CSR) is used to detect ligamentous instability. We investigated the ED use of dynamic CSR through a retrospective descriptive review using a convenience sample study design at a university emergency department. Adult blunt trauma patients with static (lateral, AP, odontoid) and dynamic (flex, extend) CSR participated. 451 patients (52% male with mean age of 33.6 years) met entry criteria. Injury mechanisms were 74% MVA, 12% fall, 8% direct trauma, and 6% other. Indications for dynamic CSR were 100% traumatic mechanism, 86% neck pain, 70% midline neck tenderness, and 18% abnormal static CSR. Static CSR were normal in 372, 5 of which had abnormal dynamic CSR (5 Cervical contour line disruption [CCLD], 2 posterior element abnormality [PEA]); of these 5 patients, none required invasive stabilization. Static CSR were abnormal in 79 patients (38 CCLD, 30 lordotic curve reversal, 17 PEA, 4 soft tissue swelling) of which 16 had abnormal dynamic CSR (9 increased CCLD, 4 PEA, and 4 fracture); of these 16 patients, 4 required invasive stabilization. Final diagnoses were 428 Cervical soft tissue injury, 11 subluxation, 8 fracture, 2 fracture-subluxation, and 2 spinal cord injury without radiographic abnormality. Spine consultation was made in 12%. Stabilization therapy was required: 21 soft collar, 4 surgical, 3 halo-device, and 5 other. No complications of dynamic CSR were noted. The blunt trauma patient with neck complaints and an abnormal static CSR was more likely to have an abnormal dynamic CSR demonstrating a Cervical injury requiring stabilization compared to patients with normal static CSR.
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Flexion-extension Cervical Spine Radiography in blunt trauma: A survey of emergency physicians
Emergency Radiology, 1998Co-Authors: William J. Brady, Narendra Kini, Christopher Duncan, Jeffrey S. YoungAbstract:A survey investigating the use of flexion-extension Cervical Spine Radiography (FE CSR) was distributed to emergency medicine physicians (EMPs). A 20-point survey was mailed to EMPs (N=250) randomly chosen from the membership of the American College of Emergency Physicians in the United States and Canada. One hundred forty-four surveys (58%) were returned. Sixty-six percent of the EMPs were emergency medicine residency-trained, and 38% of the respondents had less than 5 years of clinical experience. Practice settings included emergency departments with an annual volume of >40,000 patients (50%), community-based hospitals (66%), and level I trauma centers (41%). Eighty-seven percent of EMPs obtained FE CSR in 20% of blunt trauma patients with neck complaints. Indications for FE CSR were minimal disruption of Cervical contour lines (68%), posterior element interval widening (53%), tenderness (49%), pain (45%), soft tissue swelling (38%), and mechanism of injury (34%). Contraindications to FE CSR were altered mentation (91%), focal neurologic issue (88%), distracting injury (71%), non-English speaker (50%), and young age (defined as
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Flexion-extension Cervical Spine Radiography in pediatric blunt trauma
Emergency Radiology, 1998Co-Authors: William A. Woods, William J. Brady, Narendra Kini, Gary Pollock, Jeffrey S. YoungAbstract:Ligamentous Cervical injury may not be apparent when viewed with static Cervical Spine Radiography (CSR). Dynamic (flexion-extension) views of the Cervical Spine may aid in the identification of such injury. A retrospective descriptive study was carried out between July 1, 1990, and June 30, 1994, in an academic emergency department averaging 60,000 patient visits (of which 20% are pediatric) per year. The subjects were pediatric blunt trauma patients, 0–18 years of age. CSR was performed in the static (lateral, anteroposterior, odontoid) and dynamic (flexion and extension) views. One hundred thirty-seven patients (53% male; mean age, 12.9 years) met entry criteria. Mechanisms of injury included motor vehicle accident (57 patients, 43%), fall from a height (56 patients, 42%), and direct trauma (20 patients, 15%). Indications for CSR included a traumatic mechanism, the complaint of neck pain, and posterior midline neck tenderness on examination in all cases; abnormal static CSR was also an indication in 40 cases (30%). Results of static CSRs were normal in 93 patients (70%), all of whom had a normal dynamic CSR. Static CSRs were abnormal in 40 patients (30%), of whom 33 had a normal dynamic CSR. The 7 patients (5%) with an abnormal dynamic CSR had disruption of the lines of Cervical contour (6), and/or reversal of lordotic curve (2) noted on the static CSR. No patient required invasive Spine surgery, and all were discharged with a satisfactory neurologic outcome after hospital admission. No complications of dynamic CSR use occurred. Among patients who are alert and communicative, dynamic CSR is safe and assists in the evaluation of pediatric blunt neck trauma when patients present with pain, midline tenderness, and abnormal static CSR.
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flexion extension Cervical Spine Radiography in blunt trauma a survey of emergency physicians
Emergency Radiology, 1998Co-Authors: William J. Brady, Narendra Kini, Christopher W Duncan, Jeffrey S. YoungAbstract:A survey investigating the use of flexion-extension Cervical Spine Radiography (FE CSR) was distributed to emergency medicine physicians (EMPs). A 20-point survey was mailed to EMPs (N=250) randomly chosen from the membership of the American College of Emergency Physicians in the United States and Canada. One hundred forty-four surveys (58%) were returned. Sixty-six percent of the EMPs were emergency medicine residency-trained, and 38% of the respondents had less than 5 years of clinical experience. Practice settings included emergency departments with an annual volume of >40,000 patients (50%), community-based hospitals (66%), and level I trauma centers (41%). Eighty-seven percent of EMPs obtained FE CSR in 20% of blunt trauma patients with neck complaints. Indications for FE CSR were minimal disruption of Cervical contour lines (68%), posterior element interval widening (53%), tenderness (49%), pain (45%), soft tissue swelling (38%), and mechanism of injury (34%). Contraindications to FE CSR were altered mentation (91%), focal neurologic issue (88%), distracting injury (71%), non-English speaker (50%), and young age (defined as <6 years) (29%). With normal FE CSR, 27% would use additional studies: computed tomography (CT) (56%), oblique view (19%); and magnetic resonance imaging (MRI) (7%). EMPs reported that they did not accompany the patient in 52% of cases. The consultant physician recommended FE CSR in 71% (radiology consultation) and 41% (orthopedic or neurosurgical consultation) of cases, respectively. EMPs used FE CSR in a significant minority of blunt trauma patients along with other radiographic imaging modalities. Reasons for ordering FE CSR more often included radiographic abnormalities rather than historical or examination findings. Consultants frequently recommended their use. FE CSRs were performed most often without physician supervision.
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Flexion-extension Cervical Spine Radiography in pediatric blunt trauma
Emergency Radiology, 1998Co-Authors: William Woods, William J. Brady, Gary F. Pollock, Narendra M. Kini, Jeffrey S. YoungAbstract:Ligamentous Cervical injury may not be apparent when viewed with static Cervical Spine Radiography (CSR). Dynamic (flexion-extension) views of the Cervical Spine may aid in the identification of such injury. A retrospective descriptive study was carried out between July 1, 1990, and June 30, 1994, in an academic emergency department averaging 60,000 patient visits (of which 20% are pediatric) per year. The subjects were pediatric blunt trauma patients, 0–18 years of age. CSR was performed in the static (lateral, anteroposterior, odontoid) and dynamic (flexion and extension) views.
Camilo R. Gomez - One of the best experts on this subject based on the ideXlab platform.
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Delayed sequelae of vertebral artery dissection and occult Cervical fractures.
Neurology, 1994Co-Authors: Roekchai Tulyapronchote, John B. Selhorst, Marc D. Malkoff, Camilo R. GomezAbstract:We report three patients who developed delayed (ie, more than a week after the injury) symptoms of vertebrobasilar ischemia following motor vehicle accidents. The patients all had angiographic evidence of vertebral artery dissection and, upon further evaluation, occult fractures of the second Cervical vertebra that were not detected by simple Cervical Spine Radiography and required polytomography or CT for diagnosis. Vertebral artery dissection can result from occult Cervical Spine fractures and may present with delayed symptoms of brain ischemia.