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Die Unfallchirurgie

Erschienen in:

01.11.2005 | Originalien

Evidenzbasiertes diagnostisches Vorgehen bei Verdacht auf stumpfes HWS-Trauma

Entwicklung eines Algorithmus

verfasst von: Dr. B. A. Leidel, K.-G. Kanz, W. Mutschler

Erschienen in: Die Unfallchirurgie | Ausgabe 11/2005

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Zusammenfassung

Hintergrund

Ziel dieser Arbeit war einerseits die Darstellung der bisher publizierten, unterschiedlichen diagnostischen Vorgehensweisen bei Verdacht auf stumpfe HWS-Verletzung, sowie andererseits deren evidenzbasierte Berücksichtigung bei der Entwicklung einer Empfehlung zum adäquaten diagnostischen Vorgehen.

Material und Methoden

Mittels systematischer Literaturrecherche in Medline, Embase, National Guideline Clearinghouse, Cochrane Library sowie manueller Referenzrecherche sichteten wir relevante Veröffentlichungen zwischen 1966 und Juli 2004. Suchbegriffe waren: Cervical Spine, Cervical Vertebrae, Spinal, Spinal Cord, Injury, Trauma, Fracture, Dislocation, Imaging, Radiography, Flexion, Extension, Fluoroscopy, Computed Tomography, Computed Scanning und Magnetic Resonance Imaging. Evidenzbasiert selektierten wir die Suchergebnisse und klassifizierten sie entsprechend ihrem Evidenzgrad.

Ergebnisse

Aus insgesamt >10.000 Veröffentlichungen sichteten wir mit stringenten Kriterien 137 relevante Artikel. Der Evidenzgrad ist aufgrund mangelnder Datenlage insgesamt eingeschränkt. Wegen fehlender Klasse-I-Daten sind nur Stufe-II- bis -III-Empfehlungen möglich. Wir entwickelten einen Algorithmus für das diagnostische Vorgehen bei Verdacht auf HWS-Trauma. Dieser klinische Algorithmus setzt die komplexe Diagnostik potentieller HWS-Verletzungen in einen übersichtlichen, logisch aufgebauten und systematischen Prozess um.

Schlussfolgerungen

Der nach reproduzierbaren, evidenzbasierten Kriterien entwickelte diagnostische Algorithmus erfüllt aktuelle geforderte Standards, um die Behandlungsqualität frisch Verletzter zu maximieren. Auch durch seine nachvollziehbare Transparenz bietet er eine wesentliche Entscheidungshilfe in der Auswahl des adäquaten diagnostischen Vorgehens.

AANS — American Association of Neurological Surgeons and the Congress of Neurological Surgeons (2002) Guidelines for management of acute cervical spinal injuries. Neurosurgery 50(Suppl 3): 1–198PubMed

ACR — American College of Radiology (2004) Appropriateness criteria in suspected cervical spine trauma.http://www.acr.org abgerufen am 01.07.2004

ACS — American College of Surgeons, Committee on Trauma (2002) ATLS — Advanced trauma life support for doctors, student course manual, 7th edn. Amercian College of Surgeons, Chicago

Ajani AE, Cooper DJ, Scheinkestel CD, Laidlaw J, Tuxen DV (1998) Optimal assessment of cervical spine trauma in critically ill patients: A prospective evaluation. Anaesth Intensive Care 26(5): 487–491PubMed

Albrecht RM, Kingsley D, Schermer CR, Demarest GB, Benzel EC, Hart BL (2001) Evaluation of cervical spine in intensive care patients following blunt trauma. World J Surg 25: 1089–1096PubMed

Anglen J, Metzler M, Bunn P, Griffiths H (2002) Flexion and extension views are not cost effective in a cervical spine clearance protocol for obtunded trauma patients. J Trauma 52: 54–59PubMed

Atherton JV, Huda W (1996) Energy imparted and effective doses in computed tomography. Med Phys 23(5): 735–741PubMed

AWMF — Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften, Ärztliche Zentralstelle Qualitätssicherung (2001) Das Leitlinien-Manual. ZaeFQ 95(Suppl I): 1–8

AWMF — Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften (2003) Leitlinien für Diagnostik und Therapie in der Neurologie, 2. Aufl.http://leitlinien.net abgerufen am 01.07.2004

10.

Bachulis BL, Long WB, Hynes GD, Johnson MC (1987) Clinical indications for cervical radiographs in traumatized patient. Am J Surg 153: 473–478PubMed

11.

Bandiera G, Stiell IG, Wells GA et al. (2003) The Canadian C-spine rule performs better than unstructured physician judgment. Ann Emerg Med 42(3): 395–402PubMed

12.

Banit DM, Grau G, Fisher JR (2000) Evaluation of the acute cervical spine: A management algorithm. J Trauma 49: 450–456PubMed

13.

Barba CA, Taggert J, Morgan AS et al. (2001) A new cervical spine clearance protocol using computed tomography. J Trauma 51: 652–657PubMed

14.

Bayless P, Ray VG (1989) Incidence of cervical spine injuries in association with blunt head trauma. Am J Emerg Med 7: 139–142PubMed

15.

Beirne JC, Butler PE, Brady FA (1995) Cervical spine injuries in patients with facial fractures: A 1-year prospective study. Int J Oral Maxillofac Surg 24(1): 26–29PubMed

16.

Benzel EC, Hart BL, Ball PA, Baldwin NG, Orrison WW, Espinosa MC (1996) magnetic resonance imaging for the evaluation of patients with occult cervical spine injury. J Neurosurg 85: 824–829PubMed

17.

Berne JD, Velmahos GC, El-Tawil Q et al. (1999) Value of complete cervical helical computed tomographic scanning in identifying cervical spine injury in the unevaluable blunt trauma patient with multiple injuries: A prospective study. J Trauma 47(5): 896–902PubMed

18.

Besman A, Kaban J, Jacobs L, Jacobs LM (2003) False-negative plain cervical spine x-rays in blunt trauma. Am Surg 69(11): 1010–1014PubMed

19.

Blackmore CC, Deyo RA (1997) Specificity of cervical spine radiography: Importance of clinical scenario. Emerg Radiol 4: 283–286

20.

Blackmore CC, Emerson SS, Mann FA, Koepsell TD (1999) Cervical spine imaging in patients with trauma: Determination of fracture risk to optimize use. Radiology 211: 759–765PubMed

21.

Blackmore CC, Ramsey SD, Mann FA, Deyo RA (1999) Cervical spine screening with CT in trauma patients: A cost-effectiveness analysis. Radiology 212: 117–125PubMed

22.

Blackmore CC, Zelman WN, Glick ND (2001) Resource cost analysis of cervical spine trauma radiography. Radiology 220: 581–587PubMed

23.

Blahd WH, Iserson KV, Bjelland JC (1984) Efficacy of the posttraumatic cross table lateral view of the cervical spine. J Emerg Med 2: 243–249

24.

Bohlmann HF (1979) Acute fractures and dislocations of the cervical spine. J Bone Joint Surg Am 61: 1119–1142PubMed

25.

Bolinger B, Shartz M, Marion D (2004) Bedside fluoroscopic flexion and extension cervical spine radiographs for clearance of the cervical spine in comatose trauma patients. J Trauma 56: 132–136PubMed

26.

Bondurant F, Cotler H, Kulkarni M, McArdle CB, Harris JH (1990) Acute spinal cord injury: A study using physical exam and MRI. Spine 15: 161–168PubMed

27.

Borock EC, Gabram SG, Jacobs LM, Murphy MA (1991) A prospective analysis of a two-year experiences using computed tomography as an adjunct for cervical spine clearance. J Trauma 31: 1001–1005PubMed

28.

Bossuyt PM, Reitsma JB, Bruns DE et al. (2003) Towards complete and accurate reporting of studies of diagnostic accuracy: The STARD initiative. Clin Chem 49: 1–6PubMed

29.

Bossuyt PM, Reitsma JB, Bruns DE et al. (2003) The STARD statement for reporting studies of diagnostic accuracy: Explanation and Elaboration. Clin Chem 49: 7–18PubMed

30.

Braakman R, Penning L (1968) The hyperflexion sprain of the cervical spine. Radiol Clin Biol 37: 309–320PubMed

31.

Bracken MB, Freeman DH, Hellenbrand K (1981) Incidence of acute traumatic hospitalized spinal cord injury in the United States, 1970–1977. Am J Epidemiol 113: 615–618PubMed

32.

Brady WJ, Moghtader J, Cutcher D, Exline C, Young J (1999) ES use of flexion-extension cervical spine radiography in the evaluation of blunt trauma. Am J Emerg Med 17: 504–508PubMed

33.

Brian DG, Elizabeth UP, John M, Scott RP (1991) Delayed diagnosis of cervical spine injuries. J Trauma 31: 1622–1626PubMed

34.

Brohi K, Wilson-Macdonald J (2000) Evaluation of unstable cervical spine injury: A 6-year experience. J Trauma 49: 76–80PubMed

35.

Brooks RA, Willett KM (2001) Evaluation of the Oxford Protocol for total spine clearance in the unconscious trauma patient. J Trauma 50: 862–867PubMed

36.

Bühren V (2002) Frakturen und Instabilitäten der Halswirbelsäule. Unfallchirug 73: 1049–1065

37.

Bühren V (2000) Röntgenaufnahmen der HWS in Flexion und Extension bei akut verletzten Patienten. Unfallchirurg 103: 1014–1015

38.

Cadoux CG, White JD, Hedberg MC (1986) High yield radiographic considerations for cervical spine injuries. Ann Emerg Med 15: 738–742PubMed

39.

Chiu WC, Haan JM, Cushing BM, Kramer ME, Scalea TM (2001) Ligamentous injuries of the cervical spine in unreliable blunt trauma patients: Incidence, evaluation and outcome. J Trauma 50: 457–464PubMed

40.

Cline JR, Scheidel E, Bigsby EF (1985) A comparison of methods of cervical immobilization used in patient extrication and transport. J Trauma 25: 649–63PubMed

41.

Cox MW, McArthy M, Lemmon G, Wenker J (2001) Cervical spine instability: Clearance using dynamic fluoroscopy. Curr Surg 58: 96–100PubMed

42.

Crim JR, Moore K, Brodke D (2001) Clearing of the cervical spine in multitrauma patients: The role of advanced imaging. Sem Ultrasound CT MR 22: 283–305

43.

D’Alise MD, Benzel EC, Hart BL (1999) Magnetic resonance imaging evaluation of the cervical spine in the comatose or obtunded trauma patient. J Neurosurg 91: 4–59

44.

Daffner RH (2001) Helical CT of the cervical spine for trauma patients: A time study. AJR 177: 77–679PubMed

45.

Daffner RH (2000) Cervical radiography for trauma patients: A time-effective technique? AJR 175(5): 1309–1311PubMed

46.

Daffner RH, Brown RR, Goldberg AL (2000) A new classification for cervical vertebral injuries. Influence of CT. Skelet Radiol 23: 49–352

47.

Davies G, Deakin C, Wilson A (1996) The effect of a rigid collar on intracranial pressure. Injury 27: 47–649PubMed

48.

Davis JW, Kaups KL, Cunningham MA, Parks SN, Nowak TP, Bilello JF, Williams JL (2001). Routine evaluation of the cervical spine in head-injured patients with dynamic fluoroscopy: A reappraisal. J Trauma 50: 1044–1047PubMed

49.

Davis JW, Parks SN, Detlefs CL, Williams GG, Williams JL, Smith, RW (1995) Clearing the cervical spine in obtunded patients: The use of dynamic fluoroscopy. J Trauma 39(3): 435–438PubMed

50.

Davis JW, Phreaner DL, Hoyt DB, Mackersie RC (1993) The etiology of missed cervical spine injuries. J Trauma 34(3): 342–346PubMed

51.

Davis SJ, Teresi LM, Bradley WG, Ziemba MA, Bloze AE (1991) Cervical spine hyperextension injury: MR findings. Radiology 180: 45–251

52.

DeBehne K, Havel C (1994) Utility of prevertebral soft tissue measurement in identifying patients with cervical spine fractures. Ann Emerg Med 24: 119–1124

53.

Demetriades D, Charalambides K, Chahwan S et al. (2000) Nonskeletal cervical spine injuries: Epidemiology and diagnostic pitfalls. J Trauma 48(4): 724–727PubMed

54.

Diaz JJ, Gillman C, Morris JA, May AK, Carrillo YM, Guy J (2003) Are five-view plain films of the cervical spine unreliable? A prospective evaluation in blunt trauma patients with altered mental status. J Trauma 55: 658–664PubMed

55.

Domeier RM for the National Association of EMS Physicians, Clinical Practice Committee (1999) Indications for prehospital spinal immobilization. Prehosp Emer Care 3: 251–253

56.

Domeier RM, Evans RW, Swor RA, Rivera-Rivera EJ, Frederiksen SM (1997) Prehospital clinical findings associated with spinal injury. Prehosp Emerg Care 1: 5–11

57.

Domeier RM, Evans RW, Swor RA (1999) The reliability of prehospital clinical evaluation for potential spinal injury are not affected by the mechanism of injury. Preshosp Emerg Care 3: 332–337

58.

Domeier RM, Swor RA, Evans RW (2002) Multicenter prospective validation of prehospital clinical spine clearance criteria. J Trauma 53: 744–750PubMed

59.

Drainer EK, Graham CA, Munro PT (2003) Blunt cervical spine injuries in Scotland 1995–2000. Injury 34: 330–333PubMed

60.

Duke GJ, Green JV (2001) Outcome of critically ill patients undergoing interhospital transfer. Med J Austral 174: 122–125PubMed

61.

EAST — Eastern Association for the Surgery of Trauma (2004) East ad hoc committee on guideline development.http://www.east.org abgerufen am 01.07.2004

62.

EAST — Eastern Association for the Surgery of Trauma (2000) Practice management guidelines for identifying cervical spine injuries following trauma, with update 2000.http://www.east.org abgerufen am 01.07.2004

63.

Edwards MJR, Frankema SPG, Kruit MC, Bode PJ, Breslau PJ, van Vugt AB (2001) Routine cervical spine radiography for trauma victims: Does everybody need it? J Trauma 50: 529–534PubMed

64.

El-Khoury G, Kathol MH, Daniel WW (1995) Imaging of acute injuries of the cervical spine: Value of plain radiography, CT and MRT imaging. AJR 164: 43–50PubMed

65.

Emery SE, Pathria MN, Wilber RG, Masaryk T, Bohlman HH (1989) Magnetic resonance imaging of posttraumatic spinal ligament injury. J Spinal Disord 2(4): 229–233PubMed

66.

Ersoy G, Karcioglu O, Enginbas Y, Eray O, Ayrik C (1995) Are cervical spine X-rays mandatory in all blunt trauma patients? Eur J Med 2: 191–195

67.

Farling PA (2002) Anaesthesia in the magnetic resonance unit: A hazardous environment. Anaesth 57: 421–423

68.

Feipel V, Rondelet B, Le Pallec J, Rooze M (1999) Normal global motion of the cervical spine: An electrogoniometric study. Clin Biomech 14(7): 462–470

69.

Fischer RP (1984) Cervical radiographic evaluation of alert patients following blunt trauma. Ann Emerg Med 13: 905–907PubMed

70.

Flanders AE, Schaefer DM, Doagn HT, Mishkin MM, Gonzalez CF, Northrup BE (1990) Acute cervical spine trauma. Correlation of MRI findings with degree of neurological deficit. Radiology 177: 25–33PubMed

71.

Freemyer B, Knopp R, Piche J, Wales L, Williams J (1989) Comparison of five-view and three-view cervical spine series in the evaluation of patients with cervical trauma. Ann Emerg Med 18: 818–821PubMed

72.

Fryback DG, Thornbury JR (1991) The efficacy of diagnostic imaging. Med Decis Making 11(2): 88–94PubMed

73.

Ghanta MK, Smith LM, Polin RS, Marr AB, Spires WV (2002) An analysis of the Eastern Association for the Surgery of Trauma practice guidelines for cervical spine evaluation in a series of patients with multiple imaging techniques. Am Surg 68: 563–567PubMed

74.

Gerrelts BD, Petersen EU, Mabry J, Petersen SR (1991) Delayed diagnosis of cervical spine injuries. J Trauma 31: 1622–1626PubMed

75.

Girotti MJ, Pagliarello G, Todd TR (1988) Physician accompanied transport of surgical intensive care patients. Can J Anaesth 35: 303–308PubMed

76.

Gold MR, Siegel JE, Russel LB, Weinstein M (1996) Cost-effectiveness in health and medicine. Oxford University Press, New York

77.

Goldberg AL, Rothfus WE, Deeb ZL (1988) The impact of magnetic resonance imaging on the diagnostic evaluation of acute cervicothoracic spinal trauma. Skelet Radiol 17: 89–95CrossRef

78.

Gonzalez RP, Fried PO, Bukhalo M, Holevar MR, Falimirski ME (1999) Role of clinical examination in screening for blunt injury. J Am Coll Surg 189: 152–157CrossRefPubMed

79.

Green JD, Harle TS, Harris JH (1981) Anterior subluxation of the cervical spine: Hyperflexion sprain. AJNR 2: 243–250PubMed

80.

Green RAR, Saifuddin A (2004) Whole spine MRI in the assessment of acute vertebral body trauma. Skeletal Radiol 33: 129–135CrossRefPubMed

81.

Griffen MM, Frykberg ER, Kerwin AJ, Schinco MA, Tepas JJ, Rowe K, Abboud J (2003) Radiographic clearance of blunt cervical spine injury: Plain radiography or computed tomography scan. J Trauma 55: 222–227PubMed

82.

Griffiths HJ, Wagner J, Anglen J, Bunn P, Metzler M (2002) The use of forced flexion/extension views in the obtunded trauma patient. Skeletal Radiol 31: 587–591CrossRefPubMed

83.

Grossman MD, Reilly PM, Gillett T, Gillett D (1999) National survey of the incidence of cervical spine injury an approach to cervical spine clearance in U.S. trauma centers. J Trauma 47(4): 684–690PubMed

84.

Gupta KJ, Clancy M (1997) Discontinuation of cervical spine immobilisation in unconscious patients with trauma in intensive care units: Telephone survey in south and west region. BMJ 314: 1652–1655PubMed

85.

Hadden WA, Gillespie WJ (1985) Multiple level injuries of the cervical spine. Injury 16: 628–633CrossRefPubMed

86.

Hankins DG, Rivera-Rivera EJ, Ornato JP et al. (2001) Spinal immobilization in the field: Clinical clearance criteria and implementation. Prehosp Emerg Care 5: 88–93PubMed

87.

Hanson JA, Blackmore CC, Mann FA, Wilson AJ (2000) Cervical spine injury: A clinical decision rule to identify high-risk patients for helical CT-screening. AJR 174(3): 713–717PubMed

88.

Hanson JA, Blackmore CC, Mann FA, Wilson AJ (2000) Cervical spine injury: Accuracy of helical CT used as a screening technique. Emerg Radiol 7: 31–35CrossRef

89.

Harris MB, Kronlage SC, Carboni PA, Robert KQ, Menmuir B, Ricciardi JE, Chutkan NB (2000) Evaluation of the cervical spine in the polytrauma patient. Spine 25: 2884–2892CrossRefPubMed

90.

Hendey GW, Wolfson AB, Mower WR, Hoffman JR for the NEXUS Group (2002) Spinal cord injury without radiographic abnormality: Results of the National Emergency X-Radiography Utilization Study in blunt cervical trauma. J Trauma 53: 1–4PubMed

91.

Herr CH, Ball PA, Sargent SK, Quinton HB (1998) Sensitivity of prevertebral soft tissue measurement of C3 for detection of cervical spine fractures and dislocation. Am J Emerg Med 16: 346–349CrossRefPubMed

92.

Hills MW, Deane SA (1993) Head injury and facial injury: Is there an increased risk of cervical injury? J Trauma 34: 549–553PubMed

93.

Hoffman JR, Mower WR, Wolfson AB, Todd KH, Zucker MI for the NEXUS Group (2000) Validity of a set of clinical criteria to rule out injury to the cervical spine in patients with blunt trauma . N Engl J Med 343: 94–99CrossRefPubMed

94.

Hoffman JR, Schriger DL, Mower W, Luo JS, Zucker M (1992) Low-risk criteria for cervical spine radiography in blunt trauma: A prospective study. Ann Emerg Med 21: 1454–1460CrossRefPubMed

95.

Hoffman JR; Wolfson AB, Todd K, Mower WR (1998) Selective cervical spine radiography in blunt trauma: Methodology of the National Emergency X-Radiography Utilization Study (NEXUS). Ann Emerg Med 32: 461–469PubMed

96.

Hogan G, Mirvis S (2003) Excluding unstable cervical spine injury in the obtunded blunt trauma patient: Is MRI needed if MDCT is negative? Präsentation am 02.12.2003. In: RSNA (Radiological Society of North America) 89th Scientific Assembly and Annual Meeting, McCormick Place, Chicago

97.

Holmes JF, Mirvis SE, Panacek EA, Hoffman JR, Mower WR for the NEXUS Group (2002) Variability in computed tomography and magnetic resonance imaging in patients with cervical spine injuries. J Trauma 53: 524–530PubMed

98.

Insko EK, Gracias VH, Gupta R, Goettler CE, Gaieski DF, Dalinka MK (2002) Utility of flexion and extension radiographs of the cervical spine in the acute evaluation of blunt trauma. J Trauma 53: 426–429PubMed

99.

Jacobs LM (1986) Prospective analysis of acute cervical injury: A methodology to predict injury. Ann Emerg Med 15: 44–49PubMed

100.

Kanz K-G (1997) Traumatologische Notfälle im präklinischen und klinischen Bereich. In: Dick WF, Ahnefeld FW, Knuth P (Hrsg) Logbuch der Notfallmedizin — Algorithmen und Checklisten, 2. Aufl. Springer, Berlin Heidelberg New York, S 93–107

101.

Kanz KG, Eitel F, Waldner H, Schweiberer L (1994) Entwicklung von klinischen Algorithmen für die Qualitätssicherung in der Polytraumaversorgung. Unfallchirurg 97: 303–307PubMed

102.

Katzberg RW, Benedetti PF, Drake CM et al. (1999) Acute cervical spine injuries: Prospective MR imaging assessment at a level 1 trauma center. Radiology 213: 203–212PubMed

103.

Kaups K, Davis J (1998) Patients with gunshot wounds to the head do not require cervical spine immobilization and evaluation. J Trauma 44: 865–867PubMed

104.

Kihiczak D, Novelline RA, Lawrason JN, Ptak T, Rhea JT, Sacknoff R (2001) Should an MR scan be performed routinely after a normal clearance CT scan in the trauma patient? Experience with 59 cases. Emerg Radiol 8: 276–278

105.

Knopp R, Parker J, Tashjiian J, Ganz W (2001) Defining radiographic criteria for flexion-extension studies of the cervical spine. Ann Emerg Med 38: 31–35CrossRefPubMed

106.

Kreipke DL, Gillespie KR, McCarthy MC, Mail JT, Lappas JC, Broadie TA (1989) Reliability of indications for cervical spine films in trauma patients. J Trauma 29: 1438–1439PubMed

107.

Kulkarni MV, McArdle CB, Kopanicky D (1987) Acute spinal cord injury: MR imaging at 1.5T. Radiology 164: 837–843PubMed

108.

Lawrason JN, Novelline RA, Rhea JT, Sacknoff R, Kihiczak D, Ptak T (2001) Can CT eliminate the initial portable lateral cervical spine radiograph in the multiple trauma patient? A review of 200 cases. Emerg Radiol 8: 272–275

109.

LeBlang SD, Nunez DB (1999) Helical CT of cervical spine and soft tissue injuries of the neck. Radiol Clin North Am 37(3): 515–532CrossRefPubMed

110.

Lee HJ, Sharma V, Shan K, Gor D (2001) The role of spinal CT vs plain films in acute cervical spine trauma: A Comparative study. Emerg Radiol 8: 311–314

111.

Lewis LM, Docherty M, Ruoff BE, Fortney JP, Keltner RA Jr, Britton P (1991) Flexion-extension views in the evaluation of cervical spine injuries. Ann Emerg Med 20: 117–121PubMed

112.

Li AE, Fishman EK (2003) Cervical spine trauma: Evaluation by multidetector CT and three-dimensional volume rendering. Emerg Radiol 10: 34–39PubMed

113.

Lin JT, Lee JL, Lee ST (2003) Evaluation of occult cervical spine fractures on radiographs and CT. Emerg Radiol 10(3): 128–134CrossRefPubMed

114.

Lockey AS, Handley R, Willett K (1998) Clearance of cervical injury in the obtunded patient. Injury 29: 493–497CrossRefPubMed

115.

Lowery DW, Wald MM, Browne BJ, Tigges S, Hoffman JR, Mower WR for the NEXUS Group (2001) Epidemiology of cervical spine injury victims. Ann Emerg Med 38(1): 12–16CrossRefPubMed

116.

MacDonald RL, Schwartz ML, Mirich D, Sharkey PW, Nelson WR (1990) Diagnosis of cervical spine injury in motor vehicle crash victims: How many x-rays are enough? J Trauma 30: 392–397PubMed

117.

Mace SE (1985) Emergency evaluation of cervical spine injuries: CT versus plain radiographs. Ann Emerg Med 14: 973–975PubMed

118.

McNamara RM, Heine E, Esposito B (1990) Cervical spine injury and radiography in alert, high risk patients. J Emerg Med 8: 177–182CrossRefPubMed

119.

Michael DB, Guyot DR, Darmody WR (1989) Coincidence of head and cervical spine injury. J Neurotrauma 6: 177–189PubMed

120.

Miles KA, Finlay D (1988) Is prevertebral soft tissue swelling a useful sign in injury of the cervical spine? Injury 19: 177–179CrossRefPubMed

121.

Mirvis SE (2001) Fluoroscopically guided passive flexion-extension views of the cervical spine in the obtunded blunt trauma patient: A commentary. J Trauma 50: 868–870PubMed

122.

Mirvis SE, Diaconis JN, Chirico PA, Reiner BI, Joslyn JN, Militello P (1989) Protocol driven radiologic evaluation of suspected cervical spine injury: Efficacy study. Radiology 170: 831–834PubMed

123.

Mirvis SE, Geisler FH, Jelinek JJ, Joslyn JN, Gellad F (1988) Acute cervical spine trauma: Evaluation with 1.5T MR imaging. Radiology 166: 807–816PubMed

124.

Mirvis SE, Shanmuganathan K (1995) Trauma radiology: Part V. Imaging of acute cervical spine trauma. J Int Care Med 10: 15–33

125.

Morris CG, McBrien ME, Farling PA (2004) Anticipation and planning for anaesthesia provision within MR units in the UK. Br J Radiol 77: 216–218CrossRefPubMed

126.

Mower WR, Hoffman JR, Pollack CV, Zucker MI, Browne BJ, Wolfson AB for the NEXUS Group (2001) Use of plain radiography to screen for cervical spine injuries. Ann Emerg Med 38: 1–7CrossRefPubMed

127.

Mower WR, Oh JY, Zucker MI, Hoffman JR for the NEXUS Group (2001) Occult and secondary injuries missed by plain radiography of the cervical spine in blunt trauma patients. Emerg Radiol 8: 200–206

128.

Neifeld GL, Keene JG, Hevesy G, Leikin J, Proust A, Thisted RA (1988) Cervical injury in head trauma. J Emerg Med 6: 203–207CrossRefPubMed

129.

Nunez DB, Ahmad AA, Coin GC, LeBlang S, Becerra JL, Henry R (1994) Clearing the cervical spine in multiple trauma victims: A time-effective protocol using helical CT. Emerg Radiol 1: 273–278

130.

Nunez DB, Quencer RM (1998) The role of helical CT in the assessment of cervical spine injuries. AJR 171: 951–957PubMed

131.

Nunez DB, Zuluaga A, Fuentes-Bernardo DA, Rivas LA, Becerra JL (1996) Cervical spine trauma: How much more do we learn by routinely using helical CT? Radiographics 16(6): 1307–1318PubMed

132.

O’Malley KF, Ross SE (1988) The incidence of injury to the cervical spine in patients with craniocerebral injury. J Trauma 28: 1476–1478PubMed

133.

Orrison WW, Benzel EC, Willis BK, Hart BL, Espinosa MC (1995) MRI evaluation of acute spine trauma. Emerg Radiol 2(3): 120–125

134.

Patton JH Kralovich KA, Cuschieri J, Gasparri M (2000) Clearing the cervical spine in victims of blunt assault to the head and neck: What is necessary? Am Surg 66(4): 326–330PubMed

135.

Pollack CV, Hendey GW, Martin DR, Hoffman JR, Mower WR for the NEXUS Group (2001) Use of flexion-extension radiographs of the cervical spine in blunt trauma. Ann Emerg Med 38: 8–11CrossRefPubMed

136.

Poonnoose PM, Ravichandran G, McClelland MR (2002) Missed and mismanaged injuries of the spinal cord. J Trauma 53: 314–320PubMed

137.

Ptak T, Kihiczak D, Lawrason JN, Rhea JT, Sacknoff R, Godfrey RR, Novelline RA (2001) Screening for cervical spine trauma with helical CT: Experience with 676 cases. Emerg Radiol 8: 315–319

138.

Ptak T, Rhea JT, Novelline RA (2003) Radiation dose is reduced with a single-pass whole-body multi detector row CT trauma protocol compared with a conventional segmented method: Initial experience. Radiology 229: 902–905PubMed

139.

Ptak T, Sacknoff R, Tsao J, Lawrason JN, Rhea J, Novelline RA (2003) An evaluation of MRI in predicting mechanical instability due to ligamentous injury in trauma patients. Präsentation am 02.12.2003. In: RSNA (Radiological Society of North America) 89th Scientific Assembly and Annual Meeting, McCormick Place, Chicago

140.

Quencer RM, Bunge RP, Egnor M (1992) Acute traumatic central cord syndrome: MRI x pathological correlations. Neuroradiol 34: 85–94CrossRef

141.

Reid DC, Henderson R, Saboe L, Miller JDR (1987) Etiology and clinical course of missed spine fractures. J Trauma 27: 980–986PubMed

142.

Ringenberg BJ, Fisher AK, Urdaneta LF, Midthun MA (1988) Rational ordering of cervical spine radiographs following trauma. Ann Emerg Med 17: 792-794PubMed

143.

Roberge RJ, Wears RC, Kelly M (1988) Selective application of cervical spine radiography in alert victims of blunt trauma: A prospective study. J Trauma 28: 784–788PubMed

144.

Roberts FR (1979) Trauma of the cervical spine. Top Emerg Med 1: 63–77

145.

Rockswold GL (1981) Evaluation and resuscitation in head trauma. Minn Med 64: 81–84PubMed

146.

Ross SE, O’Mallay KF, Delong WG, Born CT, Schwab CW (1992) Clinical predictors of unstable cervical spinal injury in multiple injured patients. Injury 23: 317–319CrossRefPubMed

147.

Ross SE, Schwab CW, David ET, Delong WG, Born CT (1987) Clearing the cervical spine: Initial radiologic evaluation. J Trauma 27(9): 1055–1060PubMed

148.

Roth BJ, Martin RR, Foley K, Barcia PJ, Kennedy P (1994) Roentgenographic evaluation of the cervical spine: A selective approach. Arch Surg 129: 643–645PubMed

149.

Rybicki FJ, Knoll B, McKenney K, Zou KH, Nunez DB (2000) Imaging of cervical spine trauma: Are the anteroposterior and odontoid radiographs needed when CT of the entire cervical spine is routine? Emerg Radiol 7: 352–355

150.

Rybicki F, Nawfel RD, Judy PF, Ledbetter S, Dyson RL, Halt PS, Shu KM, Nunez DB (2002) Skin and thyroid dosimetry in cervical spine screening: Two methods for evaluation and a comparison between a helical CT and radiographic trauma series. AJR 179: 933–937PubMed

151.

Saddison D, Vanek VW, Racanelli JL (1991) Clinical indications for cervical spine radiographs in alert trauma patients. Am Surg 57: 366–369PubMed

152.

Schenarts PJ, Diaz J, Kaiser C, Carrillo Y, Eddy V, Morris JA (2001) Prospective comparison of admission computed tomography scan and plain films of the upper cervical spine in trauma patients with altered mental status. J Trauma 51: 663–669PubMed

153.

Schleehauf K, Ross SE, Civil ID, Schwab CW (1989) Computed tomography in the initial evaluation of the cervical spine. Ann Emerg Med 18: 815–817CrossRefPubMed

154.

Schnabel M, Weber M, Vassiliou T, Mann D, Kirschner M, Gotzen L, Kaluza G (2004) Diagnostik und Therapie akuter Beschwerden nach „HWS-Distorsion“ in Deutschland. Unfallchirurg 107(4): 300–306CrossRefPubMed

155.

Sees DW, Rodriguez-Cruz LR, Flaherty SF, Ciceri DP (1998) The use of bedside fluoroscopy to evaluate the cervical spine in obtunded trauma patients. J Trauma 45(4): 768–771PubMed

156.

Silberstein M, Hennessy O (1992) Prevertebral swelling in cervical spine injury: Identification of ligament injury with MRI. Clin Radiol 46: 318–323CrossRefPubMed

157.

Sliker C, Mirvis S (2003) Imaging the obtunded blunt trauma patient: Reflections on assessing cervical spine stability. Präsentation am 02.12.2003 in: RSNA (Radiological Society of North America) 89^th Scientific Assembly and Annual Meeting, McCormick Place, Chicago

158.

Spitzer WD (1995) Scientific monograph of the Quebec Task Force on whiplash-associated disorders. Spine 20: 8

159.

Stabler A, Eck J, Penning R (2001) Cervical spine: Postmortem assessment of accident injuries — comparison of radiographic, MRI, anatomic and pathologic findings. Radiology 221: 340–346PubMed

160.

Stearly HE (1998) Patients‘ outcomes: Intrahospital transportation and monitoring of critically ill patients by specially trained ICU nursing staff. Am J Crit Care 7: 282–287PubMed

161.

Stiell IG, Clement CM, McKnight RD et al. (2003) The Canadian C-spine rule versus the NEXUS low-risk criteria in patients with trauma. N Engl J Med 349(26): 2510–2518CrossRefPubMed

162.

Stiell IG, Wells GA, Vandemheen KL et al. (2001) The Canadian C-spine rule for radiography in alert and stable trauma patients. J Am Med Assoc 286(15): 1841–1848CrossRef

163.

Streitwieser DR, Knopp R, Wales LR, Williams JL, Tonnemacher K (1983) Accuracy of standard radiographic views in detecting cervical spine fractures. Ann Emerg Med 12(9): 538–542PubMed

164.

Stürmer KM (1999) Verletzungen der Halswirbelsäule (HWS). In: Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften AWMF (Hrsg) Leitlinien Unfallchirurgie, 2. Aufl. Thieme, Stuttgart New York, S 34–54

165.

Tan E, Schweitzer ME, Vaccaro L, Spetell AC (1999) Is computed tomography of nonvisualized C7-T1 cost effective? J Spinal Disord 12: 472–476PubMed

166.

Tarr RW, Drolshagen LF, Kerner TC (1987) MR imaging of recent spinal trauma. J Comp Ass Tomogr 11: 412–417

167.

Tehranzadeh J, Bonk RT, Ansari A, Mesgarzadeh M (1994) Efficacy of limited CT for nonvisualized lower cervical spine in patients with blunt trauma. Skeletal Radiol 23: 349–352PubMed

168.

Templeton P, Young J, Mirvis S, Buddemeyer EU (1987) The value retropharyngeal soft tissue measurements in trauma of the adult cervical spine. Skeletal Radiol 16: 98–100CrossRefPubMed

169.

Vandemark RM (1990) Radiology of the cervical spine in trauma patients: Practice pitfalls and recommendations for improving efficiency and communication. AJR 155: 465–472PubMed

170.

Velmahos GC, Theodorou D, Tatevossian R, Belzberg H, Cornwell EE, Berne TV, Asensio JA, Demetriades D (1996) Radiographic cervical spine evaluation in the alert asymptomatic blunt trauma victim: Much ado about nothing. J Trauma 40(5): 768–774PubMed

171.

Wang JC, Hatch JD, Sandhu HS, Delamarter RB (1999) Cervical flexion and extension radiographs in acutely injured patients. Clin Orthop 1(365): 111–116

172.

Webb JK, Broughton RB, McSweeney T, Park WM (1976) Hidden flexion injury of the cervical spine. J Bone Joint Surg Br 58(3): 322–327PubMed

173.

Weinstein MC, Stason WB (1977) Foundations of cost-effectiveness analysis for health and medical practices. N Engl J Med 31(13): 716–721

174.

White AA, Southwick WO (1976) Clinical instability in the lower cervical spine. Spine 1: 15–27

175.

Whiting P, Rutjes AWS, Reitsma JB, Bossuyt PMM, Kleijnen J (2003) The development of QUADAS: A tool for the quality assessment of studies of diagnostic accuracy included in systematic reviews. BMC Med Res Methodol 3(1): 25CrossRefPubMed

176.

Williams J, Jehle D, Cottington E, Shufflebarger C (1992) Head, facial, clavicular trauma as a predictor of cervical-spine injury. Ann Emerg 21: 719–722CrossRef

177.

Woodring JH, Lee C (1992) Limitations of cervical radiography in the evaluation of acute cervical trauma. J Trauma 34: 32–39

178.

Woodring JH, Lee C (1992) The role and limitations of computed tomographic scanning in the evaluation of cervical trauma. J Trauma 33(5): 698–708PubMed

179.

Woodring JH, Lee C, Duncan V (1993) Transverse process fractures of the cervical vertebrae: Are they significant? J Trauma 34: 797–802PubMed

180.

Young JS, Northrup NE (1979) Statistical information to some of the most commonly asked questions about SCI. Sci Dig Spring 111

181.

Zabel DD, Tinkoff G, Witenborn W, Ballard K, Fulda G (1997) Adequacy and efficacy of lateral cervical spine radiography in alert, high risk blunt trauma patients. J Trauma 43: 952–956PubMed

Titel: Evidenzbasiertes diagnostisches Vorgehen bei Verdacht auf stumpfes HWS-Trauma
Entwicklung eines Algorithmus
verfasst von: Dr. B. A. Leidel
K.-G. Kanz
W. Mutschler
Publikationsdatum: 01.11.2005
Verlag: Springer-Verlag
Erschienen in: Die Unfallchirurgie / Ausgabe 11/2005
Print ISSN: 2731-7021
Elektronische ISSN: 2731-703X
DOI: https://doi.org/10.1007/s00113-005-0968-2

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