Rational ordering of cervical spine radiographs following trauma.

A retrospective review of 312 hospitalized patients with cervical spine injuries was conducted to identify presenting signs, symptoms, and coexisting conditions, and to determine if any injuries were not diagnosed in the emergency department. Of the 257 (82%) patients who were alert on ED evaluation, 215 (84%) complained of neck pain or tenderness. Of the remaining 42 alert patients without neck pain, 34 had sensory or motor symptoms or signs suggestive of cervical spine injury, and eight had significantly painful other injuries. Of the 284 patients presenting within the first 48 hours after injury, 23 were not diagnosed initially, 21 because radiographs were initially read as negative and two because no radiographs were taken. A significant number of patients had more than one fracture of the spinal column. A stepwise approach to rational ordering of cervical spine radiographs in blunt trauma is proposed.

Role of an emergency helicopter transport service in rural trauma.

The records of 916 trauma victims transported by an emergency helicopter service were reviewed to evaluate its impact on patient outcome. According to strict criteria, the service was classified as essential, helpful, or "not a factor" in the preservation of life and/or limb in each case. The helicopter service was essential in 14.0%, helpful in 12.9%, and "not a factor" in 56.6% of patients. A fourth category included patients who, despite the delivery of maximal emergency medical care, died as a result of their injuries (16.5%). With the available initial information, it was impossible to determine prospectively which patients would benefit from air transport. We believe that the rapid evaluation of potentially serious injuries and the number of patients for whom the service proved beneficial justify its use, particularly in rural areas.