Blunt neck trauma: Difference between revisions
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==Clinical Features== | ==Clinical Features== | ||
*Signs of life-threatening neck or upper thoracic injury (look for ''TWELVE''): | *Signs of life-threatening neck or upper thoracic injury (look for ''TWELVE''): | ||
: | :Tracheal deviation'', | ||
: | :Wounds, | ||
: | :External markings, | ||
: | :Laryngeal disruption, | ||
: | :Venous distention, | ||
: | :Emphysema (surgical) | ||
*Features may include signs and symptoms of: | *Features may include signs and symptoms of: | ||
**[[Spinal cord injury]] | **[[Spinal cord injury]] | ||
Latest revision as of 09:27, 22 March 2026
Background
- Suspect vascular damage to cord, if discrepancy between neuro deficit and level of spinal column injury
- Spinal cord injury is more likely if anterior (vertebral bodies) AND posterior (spinal canal) columns are disrupted
Clinical Features
- Signs of life-threatening neck or upper thoracic injury (look for TWELVE):
- Tracheal deviation,
- Wounds,
- External markings,
- Laryngeal disruption,
- Venous distention,
- Emphysema (surgical)
- Features may include signs and symptoms of:
Pediatrics
- In a small study of 42 patients with a cervical seatbelt sign there were no isolated cerebrovascular injuries. For pediatric patients in a motor vehicle collision, the presence of an isolated seatbelt sign was not associated with any cases of cerebrovascular injury. [1]
Differential Diagnosis
Neck Trauma
- Penetrating neck trauma
- Blunt neck trauma
- Cervical injury
- Neurogenic shock
- Spinal cord injury
Other
Evaluation
Workup
- Consider x-ray or non-contrast cervical CT to evaluate for bone/cord injury (see below)
- May later consider cervical MRI to further evaluate for cord injury
- Consider CTA neck with contrast to evaluate for vascular injury (see below)
General Approach
- If concern for cervical spine injury, use a cervical spine clearance decision rule to determine need for imaging
- Perform a neuro exam, to determine concern for spinal cord injury
- If concern for vascular injury, use the Denver screening criteria
Management
- Prehospital
- Hospital
- Secure ABCs
- See cervical spine clearance
- See specific diagnosis
Disposition
- Based on specific diagnosis
See Also
- Penetrating neck trauma
- Cervical spine clearance
- Canadian cervical spine rule
- NEXUS cervical spine rule
- Strangulation
- Vertebral and carotid artery dissection
External Links
References
- ↑ Desai NK, et al. Screening CT angiography for pediatric blunt cerebrovascular injury with emphasis on the cervical “seat- belt sign.” AJNR Am J Neuroradiol. 2014 Sep;35(9):1836-40. PMID: 24722311.