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PubMed2006

Utility of screening for blunt vascular neck injuries with computed tomographic angiography.

PURPOSE: 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). METHODS: 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. RESULTS: 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 with abnormal CTAs and no angiogram. The incidence of angiographically proven BVNIs in our series was 1.1%. If four patients who were treated for BVNIs based on CTA alone are included, the incidence rises to 1.4%. This is significantly higher than the 0.17% incidence before screening (p < 0.001). In addition, the delayed stroke rate and injury-specific mortality fell significantly from 67% to 0% (p < 0.001) and 38% to 0% (p = 0.002), respectively. Overall mortality also fell significantly, from 38% to 10.5% (p = 0.049). Univariate logistic regression identified the presence of cervical spine injury as a significant predictor of BVNI (p < 0.001). CONCLUSION: CTA screening increases the detected incidence of BVNI 8-fold, with rates similar to angiographically based screening protocols. CTA screening significantly decreases BVNI-related morbidity and mortality in an efficient manner, underlying its utility in the early diagnosis of this injury.

Adult↗
PubMed1983

The prognosis of neck injuries resulting from rear-end vehicle collisions.

Injury of the neck may result when a motor vehicle is run into from behind; such injury is frequently the cause of prolonged disability and litigation. We report a series of 61 patients with these injuries. A classification, based upon the presenting symptoms and physical signs has been evolved. This classification is shown to be a reliable basis for formulating a prognosis. Factors which adversely affect prognosis include the presence of objective neurological signs, stiffness of the neck, muscle spasm, and pre-existing degenerative spondylosis.

Accidents, Traffic↗
PubMed1992

Neck injuries: II. Atlantoaxial dislocation--a pathologic study of 14 traffic fatalities.

C1-C2 vertebral dislocations have not been commonly recognized at autopsy. Among 66 subjects with neck injuries, drawn from a series of 155 traffic fatalities, were 14 with injuries at the level of the atlantoaxial motion segment, ranging in age from 8 months to 93 years. Thirteen had sprains or lacerations of the atlantoaxial facet joints, and one had a healed C1 fracture. Six of the 14 had odontoid fractures. None had transverse ligament lacerations. Injuries of the alar ligaments and the tectorial membrane were frequent. Only 3 subjects had subaxial cervical injury. All 14 had evidence of impact to the head or neck. Four had fractures of the mandible or facial bones, and 5 had skull fractures. Subdural and subarachnoid hemorrhages were found in 7 and 6, respectively. Brainstem lacerations were not uncommon, but only one had a pontomedullary laceration. Spinomedullary cord injuries occurred in 5. Acute neurogenic shock was the major mechanism of death in 9 of the 14, including 5 with major cardiovascular lacerations. Delayed effects of craniocerebral trauma accounted for the majority of the remainder. The biomechanical mechanisms are discussed.

Accidents, Traffic↗
PubMed1987

Neck injuries in ice hockey: a recent, unsolved problem with many contributing factors.

Previously unrecognized, major neck injuries in hockey have become a common problem in Canada and they have increased markedly in the 1980s. At the present time, the incidence remains high and has shown no sign of diminishing. The etiology of the problem appears to be multifactorial. Several epidemiologic factors have been identified and a reporting system established so that prevention programs can be monitored. It is hoped that greater awareness of the risk factors among players, coaches, leagues, referees, and parents will be an effective prophylactic measure in itself. Prevention must involve several approaches by hockey organizations and leagues, players, equipment manufacturers, and health care professionals and researchers.

Adolescent↗
PubMed1975

Postmortem radiology of head neck injuries in fatal traffic accidents.

A series of 146 victims of fatal traffic accidents were subjected to postmortem radiographic examination prior to medicolegal autopsy. A total of 42% were found to have radiographically demonstrable head injuries ranging from relatively simple linear skull fractures to massive skull damage. Free intracranial or intravascular air was demonstrated in more than 60%. A total of 21% had demonstrable neck injuries, most of which were localized to a single level at the craniocervical junction or the upper two cervical vertebrae. Flexion and extension studies of this area are of major importance in demonstrating the injury and locating potentially occult lesions for the forensic pathologist.

Accidents, Traffic↗
PubMed2002

Head and neck injuries in fatal motorcycle collisions as determined by detailed autopsy.

Detailed layer-by-layer autopsy of the head and neck was performed on a series of seventy-three fatally injured motorcyclists in order to identify occult soft tissue injuries such as subluxation of the cervical spine or hemorrhage of vertebral or internal carotid arteries. The fatal cases were gathered as part of a larger study of 1082 on-scene in-depth motorcycle crash investigations in Thailand. Injuries were coded using the 1990 Abbreviated Injury Scale (AIS 90) and an Injury Severity Score (ISS) was determined for each case. Twenty-eight motorcyclists had been wearing a helmet at the start of the collision sequence, but only nine helmets remained in place through the entire collision event. Both helmeted and unhelmeted motorcyclists showed a high frequency of neck injuries such as hemorrhages in the carotid sheath compressing the vagus nerve, hemorrhages surrounding the phrenic nerves or the brachial plexus, or hemorrhages surrounding the vertebral arteries. The most significant finding of this study was the identification of serious internal neck injuries even when there was no external physical evidence of trauma to the neck. Virtually all riders with significant head injuries showed some of these soft tissue neck injuries. This may be important for trauma physicians, who are presented with critically injured motorcyclists with complex multiple trauma, which may include occult soft tissue neck injuries.

Abbreviated Injury Scale↗
PubMed2002

The effects of a medical care utilization review program on back and neck injury claims.

A number of quality-based evaluation and treatment protocols have been developed and marketed for the management of work-related musculoskeletal problems. Yet, little is known about their effectiveness in improving patient outcomes. We evaluated one such approach adopted by the Department of Labor and Industries, which insures approximately two-thirds of the non-federal workforce in Washington State. The outcomes of back and neck injury claims (primarily sprains and strains) filed in the 2 months after the program was fully operational were compared with two comparable groups of claims from the same base population filed before the program's availability. There were no statistically significant differences between groups in the number of days of work loss, medical costs, and permanent partial disability awards granted during the 2 years after injury. The quality-based program used as an adjunct to claims management failed to improve outcomes.

Absenteeism↗
PubMed2000

Neck injuries caused by being run over by a motor vehicle.

We report a homicide involving the use of a motor vehicle and simulating a traffic accident. This observation was the reason for a retrospective analysis of neck injuries in victims of traffic accidents, in which a person has been run over (RO) by a motor vehicle. The autopsy material of two institutes from 1990-1996 was used. The following findings were obtained in 63 victims: laryngohyoid fractures (LH-fx): 10 cases (16%) with a clear difference between the institutes (22% versus 7%). This resulted from examination with special regard to such injuries in many cases at one of the institutes, whereas only autopsy reports were taken retrospectively from the other institute. Five of these cases had suffered only minor LH-fx (as seen frequently in strangulation), although extensive run over (RO) injuries of the other cervical tissues were present. All LH-fx were caused by direct compression of the neck; in eight of the cases they were combined with mandibular fractures. Petechial hemorrhages (petH) at the eye lids/conjunctivae were seen in 19 cases (30%); 16 of these were related to thorax RO injuries, three to abdominal RO only. Four cases involved LH-fx, petH as well as cervical skin lesions and additional cervical soft tissue hemorrhages. Interpretation can be extremely difficult with this combination of findings if the character of the event cannot be established as accidental beyond doubt on the basis of the circumstances.

Accidents, Traffic↗
PubMed1993

Neck injuries: III. Ligamentous injuries of the craniocervical articulation without occipito-atlantal or atlanto-axial facet dislocation. A pathologic study of 21 traffic fatalities.

Craniocervical ligamentous injuries without dislocation of the occipito-atlantal or atlantoaxial motion segments have been described rarely if at all. Among 155 traffic fatalities were 21 persons with such injuries. Among the 21 fatalities were 20 alar ligament injuries, eight tectorial membrane injuries, and ten injuries of the subaxial cervical spine. All 21 had craniocerebral trauma, including twelve with skull fractures, seven with facial or mandibular fractures, eight with subdural hemorrhages, twelve with subarachnoid hemorrhages, seven with cerebral contusions, five with cerebral lacerations, two with midbrain lacerations, nine with pontomedullary lacerations, and four with spinomedullary injuries. The mechanisms of death was acute neurogenic shock in seven victims, acute neurogenic shock in combination with other physiological derangements in six, acute neurogenic respiratory arrest in three, brain swelling in two, and mechanisms unrelated to head and neck trauma in three victims. In six victims, the neck injury did not contribute to death. No conclusions regarding the biomechanical mode of injury are drawn.

Accidents, Traffic↗
PubMed2003

Effects of head restraint and seat redesign on neck injury risk in rear-end crashes.

Automobile insurance claims were examined to determine the rates of neck injuries in rear-end crashes for vehicles with and without redesigned head restraints, redesigned seats, or both. Results indicate that the improved geometric fit of head restraints observed in many newer vehicle models are reducing the risk of whiplash injury substantially among female drivers (about 37% in the Ford Taurus and Mercury Sable), but have very little effect among male drivers. New seat designs, such as active head restraints that move upward and closer to drivers' heads during a rear impact, give added benefit, producing about a 43% reduction in whiplash injury claims (55% reduction among female drivers). Estimated effects of Volvo's Whiplash Injury Prevention System and Toyota's Whiplash Injury Lessening design were based on smaller samples and were not statistically significant.

Accidents, Traffic↗
PubMed1996

Neck injuries from skate blades in ice hockey: a report of three cases.

This article describes three neck slash injuries in amateur ice hockey players, with a fatal outcome in two. One player died of asphyxation secondary to hemorrhage into the respiratory passage, but the other died of hemorrhage from the main blood vessels in the neck, severed by the skate blade. All three were not wearing any neck protecting device. Neck slash injury from skate blades, as a preventable sports-related injury, and the need for neck protective equipment in preventing such injuries are discussed.

Adolescent↗
PubMed1988

A comparative study of G-induced neck injury in pilots of the F/A-18, A-7, and A-4.

The introduction of the high performance F/A-18 into the Navy and Marine Corps units has brought attention to the problem of high +Gx-induced neck pain and injury. Aviators from the Light Attack Wing, Pacific were surveyed and the results were categorized by aircraft type. We found that 74% of F/A-18 aviators surveyed reported neck pain with high +Gz. Out of 37 pilots reporting neck injury, 11 required removal from flight status averaging 3 days. The inability to function effectively during high G flight and the impact of lost pilot days highlight the need for further study into prevalence and solutions for high +Gz-induced neck injury.

Adult↗
PubMed2003

Inverted drop testing and neck injury potential.

Inverted drop testing of vehicles is a methodology that has long been used by the automotive industry and researchers to test roof integrity and is currently being considered by the National Highway Traffic Safety Administration as a roof strength test. In 1990 a study was reported which involved 8 dolly rollover tests and 5 inverted drop tests. These studies were conducted with restrained Hybrid III instrumented Anthropometric Test Devices (ATD) in production and rollcaged vehicles to investigate the relationship between roof strength and occupant injury potential. The 5 inverted drop tests included in the study provided a methodology producing "repeatable roof impacts" exposing the ATDs to the similar impact environment as those seen in the dolly rollover tests. Authors have conducted two inverted drop test sets as part of an investigation of two real world rollover accidents. Hybrid-III ATD's were used in each test with instrumented head and necks. Both test sets confirm that reduction of roof intrusion and increased headroom can significantly enhance occupant protection. In both test pairs, the neck force of the dummy in the vehicle with less crush and more survival space was significantly lower. Reduced roof crush and dynamic preservation of the occupant survival space resulted in only minor occupant contact and minimal occupant loading, establishing a clear causal relationship between roof crush and neck injuries.

Accidents, Traffic↗
PubMed2003

Studies of neck injury criteria based on existing biomechanical test data.

The mechanisms of injury of the human neck are potentially related to the forces and bending moments acting on the spinal column. An injury criterion that combines the effects of the time history of force and moment, N(ij), has been adopted by the USA federal government for vehicle crash regulations. This paper presents two analytical approaches to evaluate the N(ij) injury criterion using previously published biomechanical data: a direct fit optimization analysis and a statistical analysis. The results show that no values used in the N(ij) criterion corresponding to compressive force, extension moment and flexion moment will optimally separate the injury and non-injury cases in the biomechanical data set. Only the tensile force allows identification of the injury risk. All indications are that increasing the weight given to moment decreases the accuracy of the prediction.

Accidents, Traffic↗