Paucis Verbis: Distracting injuries in c-spine injuries

Paucis Verbis: Distracting injuries in c-spine injuries

2017-08-01T19:47:11+00:00

CervicalCollar

“Distracting injury” is a frequent cited reason for imaging the cervical spine in blunt trauma patients, per the NEXUS study. In the Journal of Trauma in 2005 and 2011, studies aimed to narrow the definition of “distracting injury”. Although both are studies at different sites, both conclude the same:

  • Chest injuries may be considered “distracting injuries” because of their proximity to the cervical spine.

Example

So let’s say you are caring for a non-intoxicated motor vehicle crash patient with an isolated tibia fracture (i.e. a “long bone fracture”), no chest injuries, and no neck pain/tenderness. Per the NEXUS criteria, you might consider this patient to have a “distracting injury” because of the long bone fracture. Instead, the literature now supports your clinically clearing the cervical spine without imaging.

Wait, let’s rethink this. Does this mean that you should get cervical spine imaging for ALL blunt trauma patients with ANY chest wall tenderness?! NO. That’s just crazy. You should still factor in the mechanism of injury, severity of pain, and your clinical gestalt.

So for me, these “distracting injury” studies are helpful such that:

  • If your trauma patient does NOT have chest trauma, it may help you avoid unnecessary cervical spine imaging, as suggested by the NEXUS criteria.
  • If your trauma patient DOES have significant chest trauma, I have a lower threshold to obtain cervical spine imaging despite the neck being non-tender.

PV Card: Distracting Injuries in Cervical Spine Assessment


Go to the ALiEM Cards site for more resources.


Michelle Lin, MD
ALiEM Editor-in-Chief
Academy Endowed Chair of EM Education
Professor of Clinical Emergency Medicine
University of California, San Francisco
Michelle Lin, MD
Michelle Lin, MD

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  • Stacey

    Thank you so much for having a separate piece on ‘distracting injury’ for your NEXUS study write up. I am in a BSN class and our instructor loves this study so we are doing a paper on it and one of his big points was to highlight the interpretation of what constitutes a ‘distracting injury’. This gives me something to work with and point to for my part in the project.

    • Happy to help, Stacey. Good luck! If you have any feedback or additional information that you find, please feel free to share with us. Thanks!