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01.10.2010 | Trauma Surgery | Ausgabe 10/2010

Archives of Orthopaedic and Trauma Surgery 10/2010

The “Innsbruck Emergency Algorithm” avoids the underdiagnosis of blunt cervical vascular injuries

Zeitschrift:
Archives of Orthopaedic and Trauma Surgery > Ausgabe 10/2010
Autoren:
Marius C. Wick, Rüdiger J. Weiss, Markus Lill, Werner Jaschke, Michael Rieger

Abstract

Objectives

Blunt cervical vascular injuries (BCVI) from alpine sports accidents bear an increased risk for being underdiagnosed during initial radiological evaluation. At our hospital, the “Innsbruck Emergency Algorithm”, which includes assessment of the neck as a computed tomography (CT) angiography during initial whole-body CT, has been introduced to avoid misdiagnoses and optimizes emergency radiology management.

Methods

Critically injured patients who were admitted for emergency CT after trauma from alpine skiing and mountain-biking accidents and who were reported with BCVI were included in this retrospective study.

Results

During 2003–2009, 36 victims were eligible for inclusion. They presented with a mean (SD) of 4.6 (2.1) diagnoses per patient, of which 3.5 (2.3) were perceptible on radiology examinations only. The “Innsbruck Emergency Algorithm” was performed in 15 individuals while 21 underwent another CT protocol including a native scan of the neck or during a parenchymatous contrast-medium phase only. In addition to BCVI, most patients (71%) were diagnosed with fractures followed by unspecific contusion/s (54%), head injuries (43%), and injuries of parenchymatous organs (19%). In five (14%), BCVI was underdiagnosed during the initial radiological examination. All of the latter had CT during a parenchymatous contrast-medium phase and not according to the “Innsbruck Emergency Algorithm”. Four of those patients died during their hospital stay. In 11, cerebral follow-up examinations showed cerebral pathologies considered as results from BCVI.

Conclusions

The “Innsbruck Emergency Algorithm” in patients with clinically unapparent BCVI after skiing and mountain-biking accidents avoided overlooking vascular injuries, which significantly improved their long-term outcome.

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