Epidemiology of Cervical Spine Injuries in The Emergency Department at The University Hospital of The West Indies, Jamaica and The Use of Clinical Decision Rules, A Retrospective Review.

Abstract

\n Background: Cervical spine injuries are myriad and ubiquitous, however the related demographic information has not been documented for the Jamaican or Caribbean population. These injuries can be life threatening and so it is important for the Emergency Physician to adhere to guidelines which direct management decisions including the need for imaging. This study therefore is an effort to report on the epidemiology of patients with cervical spine injuries presenting to the Emergency Department (ED) at the University Hospital of the West Indies (UHWI) and the use of clinical rules in the diagnosis of these injuries.This was a retrospective study. The log books from the ED at the UHWI were used to identify patients presenting with possible cervical spine injuries from January 1, 2013 to December 31, 2016. Inclusion/exclusion criteria were applied to select study patients. Demographical and clinical information was collected and evaluated.Results: 1,380 charts were identified as possible subjects. Of these, 887 charts were located and 806 (90.9%) were eligible. Ages ranged from 16 to 101 years with an average of 37.5 years. The majority of subjects were male, with a male to female ratio of 3:1. The main causes of these injuries were motor-vehicle collision (46.4%), motor-bike collision (23.8%) and fall from elevation (13.1%). Cervical spine injuries were identified in 20 (2.48%) subjects where motor-vehicle collision (45%) and motor-bike collisions (25%) were the main cause for injuries. Documentation of clinical rules applied to determine the need for radiological testing were present for 37.7% of the study population (NEXUS 36.2%, CCR 0.4% and combination 1.1%)Conclusion: The main source of injuries was due to road traffic accidents. This suggests more needs to be done regarding road safety. There is also room for improvement as it relates to the use of decision rules which may reduce the occurrence of unnecessary imaging.