Identifying Survivors With Traumatic Craniocervical Dissociation: A Retrospective Study

被引:34
作者
Cooper, Zara [1 ]
Gross, Joel A. [2 ]
Lacey, J. Matthew [3 ]
Traven, Neal [4 ]
Mirza, Sohail K. [5 ]
Arbabi, Saman [4 ,6 ]
机构
[1] Harvard Univ, Dept Surg, Brigham & Womens Med Ctr, Boston, MA 02115 USA
[2] Univ Washington, Harborview Med Ctr, Dept Radiol, Seattle, WA 98104 USA
[3] Univ Washington, Med Ctr, Dept Med, Seattle, WA 98195 USA
[4] Univ Washington, Harborview Med Ctr, Harborview Injury Prevent & Res Ctr, Seattle, WA 98104 USA
[5] Univ Washington, Harborview Med Ctr, Dept Orthoped Surg, Seattle, WA 98104 USA
[6] Univ Washington, Harborview Med Ctr, Dept Surg, Seattle, WA 98104 USA
关键词
craniocervical dissociation; atlanto occipital dissociation; autopsy study; basion-dental interval; AOD; CCD; ATLANTOOCCIPITAL DISLOCATION; CERVICAL-SPINE; OCCIPITOATLANTAL DISLOCATION; OCCIPITOVERTEBRAL RELATIONSHIPS; RADIOLOGIC-DIAGNOSIS; LATERAL RADIOGRAPHS; TRAFFIC FATALITIES; SUPINE SUBJECTS; NECK INJURIES; JUNCTION;
D O I
10.1016/j.jss.2009.04.004
中图分类号
R61 [外科手术学];
学科分类号
100210 [外科学];
摘要
Background. Traumatic craniocervical dissociation (CCD), which includes atlanto-occipital dissociation and vertical distraction between C1-C2, is often an immediately fatal injury that has increasingly been associated with survival to the hospital. Our aim was to identify survivors of CCD based on clinical presentation. Methods. We retrospectively reviewed the Harbor-view Medical Center Trauma Registry and the King County Medical Examiners data base from 2001 to 2006. Patients >= 12 y old were identified by ICD-9 code, radiographic diagnosis on lateral cervical spine films, and CT. We examined age, gender, mechanism of injury, presentation and prehospital and hospital interventions, and radiographic findings to distinguish survivors and non-survivors. Results. Of 69 patients with CCD, 47 were diagnosed post mortem, 22 were diagnosed in hospital, and seven survived to discharge. When comparing survivors and non-survivors, age, gender, and injury severity score were not significant. Survivors had significantly higher GCS, and were more likely to be normotensive; none had cervical cord injury; 80% of non-survivors had a basion-dental interval (BDI) of >= 16 mm. Conclusions. Trauma patients diagnosed with CCD in the ED, with cervical cord injury, requiring CPR, and with GCS of 3 will not survive their injury. Wider BDI is associated with mortality. (C) 2010 Elsevier Inc. All rights reserved.
引用
收藏
页码:3 / 8
页数:6
相关论文
共 24 条
[1]
ADAMS VI, 1992, J FORENSIC SCI, V37, P565
[2]
ADAMS VI, 1992, J FORENSIC SCI, V37, P556
[3]
ALKER GJ, 1978, ORTHOP CLIN N AM, V9, P1003
[4]
Diagnosis and treatment of craniocervical dislocation in a series of 17 consecutive survivors during an 8-year period [J].
Bellabarba, Carlo ;
Mirza, Sohail K. ;
West, G. Alexander ;
Mann, Frederick A. ;
Dailey, Andrew T. ;
Newell, David W. ;
Chapman, Jens R. .
JOURNAL OF NEUROSURGERY-SPINE, 2006, 4 (06) :429-440
[6]
PATHOLOGICAL ANATOMY OF FATAL ATLANTO-OCCIPITAL DISLOCATIONS [J].
BUCHOLZ, RW ;
BURKHEAD, WZ .
JOURNAL OF BONE AND JOINT SURGERY-AMERICAN VOLUME, 1979, 61 (02) :248-250
[7]
THE ETIOLOGY OF MISSED CERVICAL-SPINE INJURIES [J].
DAVIS, JW ;
PHREANER, DL ;
HOYT, DB ;
MACKERSIE, RC .
JOURNAL OF TRAUMA-INJURY INFECTION AND CRITICAL CARE, 1993, 34 (03) :342-346
[8]
CRUCIATE PARALYSIS - A CLINICAL AND RADIOGRAPHIC ANALYSIS OF INJURIES TO THE CERVICOMEDULLARY JUNCTION [J].
DICKMAN, CA ;
HADLEY, MN ;
PAPPAS, CTE ;
SONNTAG, VKH ;
GEISLER, FH .
JOURNAL OF NEUROSURGERY, 1990, 73 (06) :850-858
[9]
Traumatic atlanto-occipital dislocation: A potentially survivable injury [J].
Ferrera, PC ;
Bartfield, JM .
AMERICAN JOURNAL OF EMERGENCY MEDICINE, 1996, 14 (03) :291-296
[10]
Fisher CG, 2001, CAN J SURG, V44, P412