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2001, Number 3

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Trauma 2001; 4 (3)

Clinical and Radiological Correlation of Cervical Lesions in a Research Performed by the Mexican Red Cross, Guadalajara Delegacy, from December 1998 to February 1999

Cervantes GRA, Velez HC, Hinojosa M, Díaz E, Chagollán A, Estrada PR, Suárez CMA, Aguilar DL, Loreto OJ, Larios DC

Language: Spanish
References: 52
Page: 87-98
PDF size: 416.67 Kb.


ABSTRACT

The number of patients admitted in emergency rooms due to traumas indicating cervical lesion is noted more and more on a daily basis. On many occasions the unavailability of neurosurgeon or orthopedist to evaluate these patients, forces us to find new protocols in the management of these patient. The following is a prospective, observational, open transversal and sequential study realized at the Mexican Red Cross, Guadalajara. The study compares the sign and symptoms of cervical lesions with lateral, AP and transoral radiographs of the cervical region. It is confirmed that all cervical lesions lesions have clinical and physical manifestations. The data was gathered during three months from patients that were admitted to the emergency room suffering diferent types of injury. The variety of the injuries included those as simple as a fall from their own height to injuries from higway accidents which was the cause of death of many of these patients beging handled by paramedics. All of the injuried were evaluated by emergency cervical exploration (ECE). See table 1. There were a total of 387 patients from which 24 cases are mentiones separately due to the inability to contribute information because they were younger than 2 year of age, or they were patients in critical conditions, in 100% of these there was no radiological alteration in the three mentioned projections. In the remaining 363 patients it was observed that 11% of them on examination showed sign of pain in the cervical region in the accord with the Analog Verbal Response Scale (AVRS). Observing 64 with cervical pain and 32 of them with cervical rectification. 89% of the remaining patient did not have any symptoms indicating cervical injury. On Physical exploration only 10% of the 363 patient, referred pain from movement during the physical examinations and 90% were normal. The radiological findings show in figure 9, show that 91 were normal and only 9% showed some abnormality. In the patients with radiological abnormalities 100% of them showed some alteration in ECE. It was observed that 100% of the patients with normal ECE also had a normal lateral cervical radiography. See figure 10. We conclude that an emergency cervical exploration is fundamental for diagnosis and radiological data is only assisting in confirmation of diagnosis. Furthermore a lateral cervical radiograph was unnecessary for patients with normal ECE. In addition during the investigation, we assembled a table suggesting the risk factors during a cervical lesion and taking a radiograph. The history was evaluated on 5 points, the question 7 points and physical exploration 8 points, totaling 20 points. 0 points indicate no risk factor, 1-7 points indicate low risk factor, 8-13 moderate risk factor and 14-20 indicate high risk factor. And as a golden rule all patients with anesthesy of the extremities should be suspected of an important cervical lesion.


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