Risk Factors for Cervical Spine Injury in an Obtunded Blunt Trauma Patient

Background: In Thailand, many hospitals cannot send every obtunded blunt trauma patient for cervical spine CT scan because of the socioeconomic status. Knowing about the risk factors for cervical spine injury in an obtunded blunt trauma patient would help the clinician monitor for cervical spine injury. Objective: To identify the risk factors of cervical spine injury in an obtunded blunt trauma patient. Materials and Methods: The present study evaluated 400 obtunded blunt trauma patients with a GCS of less than 15, in the trauma center of Srinagarind Hospital between January 2015 and December 2019. The patients were chosen from the patient’s registry for the present retrospective cross-sectional study. A univariate analysis was fulfilled with potential risk factors such as age, gender, mechanism of injury, GCS, associated injury, and intracranial lesion. Then, multivariate analysis was used to identify the risk factors of cervical spine injury in obtunded blunt trauma patients. Results: Four hundred patients were included in the present study. Eighty-eight (22%, 95% CI 18.04 to 26.38) had a cervical spine injury. The mean age was 40.04 years, 73% were males with a male to female ratio of 2.7 to 1. For the mechanisms of injury, 66% of injuries resulted from motorcycle accidents, 15% from car accidents, and 14% from falls. From univariate analysis, age older than 60 years had significant higher odds of cervical spine injury than age younger than 60 years (OR 1.93, 95% CI 1.05 to 3.54). Thoracic spine fracture had significant higher odds of cervical spine injury than other associate injuries (OR 6.2, 95% CI 1.45 to 26.5). From multivariate analysis, age older than 60 years had significant higher odds of cervical spine injury than age younger than 60 years (aOR 1.99, 95% CI 1.07 to 3.68). Thoracic spine fracture had a significantly higher odds of cervical spine injury than the other associated injuries (aOR 6.4, 95% CI 1.48 to 27.63). In patients age older than 60 years, 42% of cervical spine injuries occurred from fall. Conclusion: From the present study, age older than 60 years and thoracic spine fracture are the significant risk factors of cervical spine injury in obtunded blunt trauma patients. Keywords: Cervical spine injury; Risk factors; Obtunded blunt trauma patient

Incidental appendicitis in a blunt trauma patient: a case report

Acute appendicitis is a relatively common disease, but it is rarely caused by trauma. There are some reports on appendicitis caused by blunt abdominal trauma, but the pathophysiology is still uncertain. In this report, we presented a case of a patient who developed acute appendicitis following blunt trauma to the abdomen sustained during a motor vehicle accident.