Piatt developed a model for predicting the probability of a cervical spine injury in a comatose trauma patient. This can help identify patients in whom cervical spine injury has been overlooked. The author is from St. Christopher's Hospital for Children and University College of Medicine in Philadelphia.
Patient selection: traumatic brain injury and admission Glasgow coma score <= 8.
Criteria for cervical spine injury:
(1) cervical spine fracture
(2) dislocated cervical spinal cord injury
Parameters:
(1) Glasgow Coma Score (GCS)
(2) age
(3) mechanism of injury
(4) hypotension
(5) facial fracture
(6) thoracolumbar spine fracture
NOTE: I found portions of the text obtuse. It appears as if the parameters are scored according to Table 1 rather than using values for GCS and age.
|
Parameter |
Finding |
Points |
|
Glasgow coma score |
3 |
0 |
|
|
4 to 8 |
1 |
|
age in years |
0 to 15 years of age |
0 |
|
|
16 to 30 years |
1 |
|
|
31 to 50 years |
2 |
|
|
51 - 69 years (> 50 years) |
3 |
|
mechanism of injury |
none of the below (other) |
0 |
|
|
bicycle accident |
1 |
|
|
fall |
2 |
|
|
motor vehicle. motorcycle or pedestrian |
3 |
|
hypotension |
absent |
0 |
|
|
present |
1 |
|
facial fracture |
absent |
0 |
|
|
present |
1 |
|
thoracolumbar spine fracture |
absent |
0 |
|
|
present |
1 |
|
limb fracture |
absent |
0 |
|
|
present |
1 |
where:
• The scoring for age only goes to 69 years of age. The scoring for hypotension includes ages > 70 years. No restrictions on age are given in the text. Based on this I will score age > 50 as 3 points.
|
Age in Years |
Admission Systolic Blood Pressure and Criteria for Hypotension |
|
0 to 15 |
< 70 mm Hg |
|
16 to 69 |
< 80 mm Hg |
|
>= 70 |
< 90 mm Hg |
X =
= (0.157 * (points for facial fracture)) + (0.231 * (points for hypotension)) - (0.218 * (points for GCS)) + (0.678 * (points for thoracolumbar spine)) + (0.299 * (points for limb fracture)) + (0.264 * (points for age)) + (0.417 * (points for mechanism)) - 4.030
probability of cervical spine injury =
= 1 / (1 + EXP((-1) * X))
Specialty: Surgery, orthopedic, Emergency Medicine, Critical Care, Surgery, general, Otolaryngology
ICD-10: ,
