CERVICAL SPINE ASSESSMENT IN ACUTE TRAUMA: ARE WE FOLLOWING ATLS GUIDELINES?

Abstract

To assess whether the ATLS guidelines were being followed within the Accident and Emergency department of a major DGH and suggest a protocol for assessment in future cases.

The case records and original X-rays of one hundred sequential patients presenting to the Royal Gwent Hospital who received cervical spine x-rays were reviewed retrospectively. Data sets were recorded for each patient including mechanism of injury, recorded opinion of the cervical spine film, diagnosis within the accident and emergency and discharge or admission. The cervical spine films were then reviewed by the authors and assessed for adequacy of visualisation of the C7-T1 junction as required by the ATLS guidelines.

Of the 100 patients 34 of the films assessed were found to have inadequate visualisation of the C7-T1 junction as required by the ATLS guidelines. Swimmers’ views had been obtained in 12 of these patients. The age range was from 9 to 83 years of age.

21 of the 34 had been involved in Road traffic Accidents, 7 in falls, 4 in sport, 1 in an assault and 1 was a case of spontaneous onset neck pain. Diagnoses included neck sprain in 17 cases, bruising in 3 cases, and whiplash in 3 cases. No diagnosis was offered in 11 cases. No specialist opinion was obtained for any of the 34 cases who received inadequate visualisation of their cervical spine. 56 of the 100 patients had satisfactory visualisation of the C7-T1 junction. Films were unavailable for 9 patients.

Visualisation of C7-T1 acute cervical trauma can be difficult. The use of swimmers’ views is a helpful adjunct but these can be difficult to interpret. In the absence of adequate visualisation of the C7-T1 junction injury cannot be excluded. A specialist or senior opinion should be sought with recourse to CT or MRI imaging if cervical spine pathology is suspected, but not excluded with initial radiographs.