Practice management guidelines for the screening of thoracolumbar spine fracture

被引:63
作者
Diaz, Jose J., Jr.
Cullinane, Daniel C.
Altman, Daniel T.
Bokhari, Faran
Cheng, Joseph S.
Como, John
Gunter, Oliver
Holevar, Michele
Jerome, Rebecca
Kurek, Stanley J., Jr.
Lorenzo, Manuel
Mejia, Vicente
Miglietta, Maurizio
O'Neill, Patrick J.
Rhee, Peter
Sing, Ronald
Streib, Erik
机构
[1] Vanderbilt Univ, Med Ctr, Div Trauma & Surg Crit Care, Nashville, TN 37212 USA
[2] Mayo Clin, Dept Surg, Rochester, MN USA
[3] W Penn Allegheny Hlth Syst, Dept Orthoped Surg, Pittsburgh, PA USA
[4] John H Stroger Jr Hosp Cook Cty, Dept Trauma, Chicago, IL USA
[5] Case Western Reserve Univ, Metrohlth Med Ctr, Dept Surg, Cleveland, OH 44106 USA
[6] Mt Sinai Hosp, Div Trauma & Surg Crit Care, Cleveland, OH USA
[7] Med Univ S Carolina, Div Trauma, Charleston, SC USA
[8] St Francis Hosp & Med Ctr, Hartford, CT USA
[9] Erlanger Hosp, Dept Surg, Chattanooga, TN USA
[10] NYU, Med Ctr, Div Acute Surg, New York, NY 10016 USA
[11] Maricopa Cty Gen Hosp, Ctr Trauma, Div Trauma & Surg Crit Care, Phoenix, AZ USA
[12] Univ So Calif, Los Angeles Cty Med Ctr, Navy Trauma Training Ctr, Div Surg, Los Angeles, CA 90033 USA
[13] Carolinas Med Ctr, Dept Gen Surg, Charlotte, NC 28203 USA
[14] Indiana Univ, Sch Med, Div Trauma Crit Care, Indianapolis, IN 46204 USA
[15] Duke Univ, Med Ctr, Dept Surg, Durham, NC 27710 USA
来源
JOURNAL OF TRAUMA-INJURY INFECTION AND CRITICAL CARE | 2007年 / 63卷 / 03期
关键词
D O I
10.1097/TA.0b013e318142d2db
中图分类号
R4 [临床医学];
学科分类号
1002 [临床医学]; 100602 [中西医结合临床];
摘要
Background: Fractures to the thoracolumbar spine (TLS) commonly occur because of major trauma mechanisms. In one series, 4.4% of all patients arriving at a Level I trauma center were diagnosed as having TLS fracture. Approximately 19% to 50% of these fractures in the TLS region will be associated with neurologic damage to the spinal cord. To date there are no randomized studies and only a few prospective studies specifically addressing the subject. The Eastern Association for the Surgery of Trauma organization Practice Management Guidelines committee set out to develop an EBM guideline for the diagnosis of TLS fractures. Methods: A computerized search of the National Library of Medicine and the National Institutes of Health MEDLINE database was undertaken using the PubMed Entrez (www.pubmed.gov) interface. The primary search strategy was developed to retrieve English language articles focusing on diagnostic examination of potential TLS injury published between 1995 and March 2005. Articles were screened based on the following questions. (1) Does a patient who is awake, nonintoxicated, without distracting injuries require radiographic workup or a clinical examination only? (2) Does a patient with a distracting injury, altered mental status, or pain require radiographic examination? (3) Does the obtunded patient require radiographic examination? Results: Sixty-nine articles were identified after the initial screening process, all of which dealt with blunt injury to the TLS, along with clinical, radiographic, fluoroscopic, and magnetic resonance imaging evaluation. From this group, 32 articles were selected. The reviewers identified 27 articles that dealt with the initial evaluation of TLS injury after trauma. Conclusion: Computed tomography (CT) scan imaging of the bony spine has advanced with helical and currently multidetector images to allow reformatted axial collimation of images into two-dimensional and three-dimensional images. As a result, bony injuries to the TLS are commonly being identified. Most blunt trauma patients require CT to screen for other injuries. This has allowed the single admitting series of CT scans to also include screening for bony spine injuries. However, all of the publications fail to clearly define the criteria used to decide who gets radiographs or CT scans. No study has carefully conducted long-term follow-up on all of their trauma patients to identify all cases of TLS injury missed in the acute setting.
引用
收藏
页码:709 / 718
页数:10
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