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Unconscious patients with multiple injuries present a major diagnostic and therapeutic problem. The incidence of neurological deficit increases if diagnosis of a spinal injury is delayed or missed. Thoracolumbar fractures are commonly the result of high energy injuries and in an unconscious patient the risk of missing such fractures is increased considerably. There is little consensus on which blunt trauma patients warrant thoracolumbar spine films when no pain, tenderness, neurological deficit or cervical spine injuries are identified.
We present a retrospective analysis of all patients who were admitted to the Major Injuries Unit at the Birmingham General Hospital and underwent radiological survey of the thoracolumbar spine. Of the 110 patients, all spinal fractures were detected in 94 patients with a Glasgow Coma Scale (GCS) ≥ 11. Of the 16 with a GCS ≤ 10, 9 patients had sustained injuries of their thoracolumbar spine 4 of which were not detected initially due to a decreased level of consciousness.
The common features amongst the 4 patients with missed injuries were:
- 1.(1) High velocity injury.
- 2.(2) Decreased level of consciousness on admission.
- 3.(3) Associated head injury.
- 4.(4) Pelvis/lower extremity injury.
We describe the four cases and identify a group of high risk patients for thoracolumbar fractures. Radiological examination of the thoracolumbar spine is essential in this group.
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- Delayed identification of skeletal injury in multisystem trauma: the missed fracture.J Trauma. 1989; 29: 1643-1646
- The tertiary trauma survey: a prospective study of missed injury.J Trauma. 1990; 30: 666
- Delayed diagnosis of extremity injuries in patients with multiple injuries.J Trauma. 1991; 31: 257-260
- Diagnostic failures in the multiply injured.J Trauma. 1980; 20: 684-687
- Etiology and clinical course of missed spine fractures.J Trauma. 1987; 27: 980-986
- Falls and major injuries are risk factors for thoracolumbar fractures: cognitive impairment and multiple injuries impede the detection of back pain and tenderness.J Trauma. 1995; 38: 692-696
- Unrecognised injuries in patients referred for emergency microsurgery.J Trauma. 1993; 34: 238
- Acute fractures and dislocations of the cervical spine.JBJS. 1979; 61A: 1114-1119
- Multiple non-contigous injuries to the spine.Acta Orthop Scand. 1976; 47: 52-58
- Multiple level spinal injuries: importance of early recognition.Am J Roentgenol. 1974; 130: 665-667
- Initial assessment and management.Advanced Trauma Life Support Course for Physicians, Instructors Manual. 1993; : 17-46
- Making the best use of a Department of Clinical Radiology. 3rd ed. Guidelines for Doctors. 79. The Royal College of Radiologists, London1995
- Acute treatment of spinal cord injuries.in: Total care of spinal cord injuries. Little Brown, Boston1977: 1-53
- Spine trauma and associated injuries.J Trauma. 1991; 31: 43-48
- Surgery of spine trauma.Churchill Livingstone, New York1989
- Double fractures of the spine — an indication for routine radiographic examination of the entire spine after injury.S Afr Med J. 1977; 51: 411-413
- Routine radiologic evaluation of the thoracolumbar spine in blunt trauma patients: a reappraisal.J Trauma. 1993; 34: 85-89
- The etiology of missed cervical spine injuries.J Trauma. 1993; 34: 342
Accepted: June 6, 1997
© 1998 Published by Elsevier Inc.