- Email: [email protected]
Operative treatment of cervical spine fractures—A 10 year review
118
Abstracts
days that followed the attacks. Understanding the natural history of their clinical course and the burden they present to medical services is important when contingency planning for future major incidents. Methods: We conducted a retrospective case note review from patients admitted to the intensive care units of the involved hospitals from the 7 July major incident. Results: There were 700 casualties in total with 52 immediate fatalities and only 3 subsequent inhospital deaths. Twenty patients were admitted to intensive care units across London leading to a total of 209.28 days of ITU admission (mean length of stay = 10.46 days, mean APACHE II score = 12.74, mean SAPS II score = 31.68). These patients all arrived within the same 2 h period. Discharge and transfer of existing ICU patients was required to make beds available for these casualties. Conclusions: The logistic load resulting from a major incident is predominantly associated with the identification and treatment of critically injured casualties and the high rate of arrival of these patients. Objectively London coped well with the July 7 casualty load, however, to cope with significantly higher numbers we need to be able to better exploit spare capacity across the region and move towards a networked response in London. Keywords: injury
Major incident; Mass casualty; Blast
doi:10.1016/j.injury.2006.12.066 SESSION: SPINE O42 Operative treatment of cervical spine fractures— –A 10 year review A. Gibson ∗ , A. Gandhe, R. Freeman, J. WilsonMacDonald John Radcliffe Hospital, UK A review of surgically treated cervical spine fractures, undertaken in a university hospital is presented. Cases of cervical spine fracture were identified from operative diaries and from the later computerised databases of our unit. The medical records were then reviewed to record patient demographics, mechanism of injury, injury level, presence of neurological involvement, surgical approach, instrumentation used, hospital stay, residual symptoms and duration of clinical follow-up. The commonest mechanism of injury was by road traffic accident. Sporting injuries and falls
made up most of the remainder. The lower segments were the most commonly injured levels; odontoid injuries were common in the upper part. There were few complications directly attributable to surgery. Modern surgical treatment of cervical spine fractures in this series proved safe with good outcomes and a low level of complications. Keywords: Cervical; Fracture; Surgery doi:10.1016/j.injury.2006.12.067 O43 Spinal injuries following major motor vehicle crashes D. Mahadeva b,∗ , Y. Kwong a , M. Chong a , A. Hassan a a Birmingham b Wansbeck
Automotive Safety Centre, UK General Hospital, UK
Introduction: The epidemiology of spinal injuries following serious motor vehicle accidents is not well known. In this study, we describe the mechanisms of injury, patient characteristics and spinal injury distribution and severity. We also aim to describe the associated injuries in these patients. Methods: Data was extracted from the Cooperative Crash Injury Study (CCIS) database, maintained by Transport Research Laboratory, UK. From June 1998 to January 2006, patients who were prospectively coded as having spinal injuries were identified. Injury severity of single injuries was coded using the Abbreviated Injury Severity (AIS) score, and overall severity was calculated for each occupant using the Injury Severity Score (ISS). We excluded all AIS 1 (minor) injuries from the analysis. Results: During the study period, 4405 occupants were identified as having sustained a spinal injury. After excluding AIS 1 injuries, there were 457 occupants left. Drivers (63.7%) and young males in the age group 18—34 (26.3%) were the dominant group. The cervical spine (53.2%) was the spinal region most commonly involved and also accounted for most of the severe AIS 5 and 6 spinal injuries. The thoracic spine (30.9%) was the next most involved followed by the lumbar spine (24.7%). There was a high overall mortality (41.6%), and this was most marked amongst the over 65 age group (60%). The majority of occupants had a significant non-spinal AIS ≥2 injury (89.5%). Discussion: The cervical spine is the most vulnerable part of the vertebral column during MVCs. Overall mortality, especially in the elderly is high, and prompt identification of associated injuries is
Abstracts
days that followed the attacks. Understanding the natural history of their clinical course and the burden they present to medical services is important when contingency planning for future major incidents. Methods: We conducted a retrospective case note review from patients admitted to the intensive care units of the involved hospitals from the 7 July major incident. Results: There were 700 casualties in total with 52 immediate fatalities and only 3 subsequent inhospital deaths. Twenty patients were admitted to intensive care units across London leading to a total of 209.28 days of ITU admission (mean length of stay = 10.46 days, mean APACHE II score = 12.74, mean SAPS II score = 31.68). These patients all arrived within the same 2 h period. Discharge and transfer of existing ICU patients was required to make beds available for these casualties. Conclusions: The logistic load resulting from a major incident is predominantly associated with the identification and treatment of critically injured casualties and the high rate of arrival of these patients. Objectively London coped well with the July 7 casualty load, however, to cope with significantly higher numbers we need to be able to better exploit spare capacity across the region and move towards a networked response in London. Keywords: injury
Major incident; Mass casualty; Blast
doi:10.1016/j.injury.2006.12.066 SESSION: SPINE O42 Operative treatment of cervical spine fractures— –A 10 year review A. Gibson ∗ , A. Gandhe, R. Freeman, J. WilsonMacDonald John Radcliffe Hospital, UK A review of surgically treated cervical spine fractures, undertaken in a university hospital is presented. Cases of cervical spine fracture were identified from operative diaries and from the later computerised databases of our unit. The medical records were then reviewed to record patient demographics, mechanism of injury, injury level, presence of neurological involvement, surgical approach, instrumentation used, hospital stay, residual symptoms and duration of clinical follow-up. The commonest mechanism of injury was by road traffic accident. Sporting injuries and falls
made up most of the remainder. The lower segments were the most commonly injured levels; odontoid injuries were common in the upper part. There were few complications directly attributable to surgery. Modern surgical treatment of cervical spine fractures in this series proved safe with good outcomes and a low level of complications. Keywords: Cervical; Fracture; Surgery doi:10.1016/j.injury.2006.12.067 O43 Spinal injuries following major motor vehicle crashes D. Mahadeva b,∗ , Y. Kwong a , M. Chong a , A. Hassan a a Birmingham b Wansbeck
Automotive Safety Centre, UK General Hospital, UK
Introduction: The epidemiology of spinal injuries following serious motor vehicle accidents is not well known. In this study, we describe the mechanisms of injury, patient characteristics and spinal injury distribution and severity. We also aim to describe the associated injuries in these patients. Methods: Data was extracted from the Cooperative Crash Injury Study (CCIS) database, maintained by Transport Research Laboratory, UK. From June 1998 to January 2006, patients who were prospectively coded as having spinal injuries were identified. Injury severity of single injuries was coded using the Abbreviated Injury Severity (AIS) score, and overall severity was calculated for each occupant using the Injury Severity Score (ISS). We excluded all AIS 1 (minor) injuries from the analysis. Results: During the study period, 4405 occupants were identified as having sustained a spinal injury. After excluding AIS 1 injuries, there were 457 occupants left. Drivers (63.7%) and young males in the age group 18—34 (26.3%) were the dominant group. The cervical spine (53.2%) was the spinal region most commonly involved and also accounted for most of the severe AIS 5 and 6 spinal injuries. The thoracic spine (30.9%) was the next most involved followed by the lumbar spine (24.7%). There was a high overall mortality (41.6%), and this was most marked amongst the over 65 age group (60%). The majority of occupants had a significant non-spinal AIS ≥2 injury (89.5%). Discussion: The cervical spine is the most vulnerable part of the vertebral column during MVCs. Overall mortality, especially in the elderly is high, and prompt identification of associated injuries is